Billing for Vaccines

Here are a few tips for billing vaccines (CPTs 90460 & 90461 Immunization codes through 18 years of age via any route of administration)

Are you including all of the administration units for vaccine components?

Knowing how many components are in each vaccine and adding the correct units for these codes will increase revenue when the number of administration units are properly coded and billed!

Caution: 90461 is an add-on code and should never be billed without 90460.

Example: A 6 year old male comes in for his annual preventative visit (99393-25) and receives all of his age-appropriate vaccines. He receives DTaP (90700), MMR (90707), IPV (90713) and Varicella (90716) vaccines. He also receives an influenza vaccine (90686). In addition to the preventative office visit and vaccine CPT codes, 9 vaccine administration units should be billed as follows:

• 99393 – Preventative Office Visit, 5-11 years of age
• 90700 – DTaP Vaccine (3 components)
• 90707 – MMR Vaccine (3 components)
• 90713  – IPV (1 component)
• 90716  – Varicella virus vaccine (1 component)
• 90686 –  Influenza vaccine (1 component)
• 90460 – Vaccine admin x 5 units (1^st component of each vaccine)
• 90461 – Vaccine