New Vaccine Admin codes

Last week I had a family practice office ask about the new vaccine admin codes that went into effect on Jan 1, 2011. They were confused on when and how you would use them.

The new codes: 90460 and 90461 have replaced the code range 90465-90468 for use when the physician provides counseling to the patients along with the vaccination. You would still use the new codes along with the code identfying the medication administered such as the code 90633 - 90634 for Heb, and 90645 for Hib, and 90680 for rotovirus.

The first new code, 90460 is used to identify the first vaccine component and 90461 is used for each for all additional components in which the physician provided administration AND counseling. 90461 is also noted as an add on code and can not be billed without 90460. Also important to note in the description is that both of the new codes are for administration and counseling in children 18 or younger as opposed to the codes they replaced that had an age limit of 8 years of age.

So what this means is if a nine year old child came in for MMR shot, and the physician provided counseling they would bill out administration for three components: measles, mumps, and rubella, which would be 90460, 90461 x 2

The American Acadmey of Pediatrics has recommended that the code 90461 is billed on one line item with the number of units rather than two sepearte line items of 90461. For more information and some FAQ's, please see their website at:

http://practice.aap.org/content.aspx?aid=2980

You would use still use 90471 and 90472 if there is NO counseling such as flu clinics where patients just walk in, get a shot, and walk out or for patients over the age of 18.