90460 CPT Code and 90461 CPT Code

CPT Codes 90460 and 90461 are specific to immunization administration for patients up to 18 years old. 90460 CPT Code is used for the first or only component of each vaccine, inclusive of counseling, whereas 90461 CPT Code should be used for each additional component within a vaccine. These codes are essential for reporting combination vaccines accurately. It is important to use both codes when administering vaccines with multiple components to ensure proper billing.

Pediatric vaccines are composed of various components, such as antigens, adjuvants, preservatives, and stabilizers. Each vaccine typically contains multiple components, and the number can vary depending on the vaccine. When reporting pediatric vaccines, it is crucial to use the appropriate Immunization Administration (IA) codes: 90460 CPT Code is for the first component and 90461 CPT Code is for each additional component administered.

For example, if a patient receives a combination vaccine like Prevnar 13 (which contains 13 different pneumococcal antigens), 90460 CPT Code would be used once for the first component, and 90461 CPT Code would be used 12 additional times for the remaining components of the vaccine.

Can we report code 90460 CPT Code more than once, on a single encounter?

Yes, it is possible and allowable to report 90460 CPT Code more than once in a single encounter. Each vaccine administered is its own entity, so for each individual vaccine administered, 90460 CPT Code should be reported because every vaccine will have at least one vaccine component. Reporting 90460 CPT Code multiple times allows you to designate each vaccine administered separately during the course of a single patient encounter. In addition to 90460, code 90461 may also be reported for multiple component vaccines. For instance, if both a measles, mumps, and rubella (MMR) vaccine and a varicella vaccine are administered in a single encounter, you would report codes 90460, 90461, and 90461 for the MMR vaccine, and 90460 for the varicella vaccine. This ensures accurate coding and billing for each specific vaccine component given to the patient.

How many components are in the common pediatric vaccines and how to report immunization administration code?

• Hepatitis A – 1 component (90460)
• Hepatitis B – 1 component (90460)
• Varicella (Chickenpox) – 1 component (90460)
• Polio Vaccine (IPV) – 1 component (90460)
• Hib (Haemophilus influenzae type b): Contains 1 component – Haemophilus influenzae type b polysaccharide. (90460)
• Td vaccine (Tetanus and Diptheria): 2 components (90460,90461)
• DTaP (Diphtheria, Tetanus, Pertussis): Contains 3 components – diphtheria toxoid, tetanus toxoid, and pertussis antigens. (90460,90461,90461)
• MMR (Measles, Mumps, Rubella): Contains 3 components (90460,90461,90461)
• Tdap (Tetanus, Diphtheria, Pertussis): Contains 3 components – diphtheria toxoid, tetanus toxoid, and acellular pertussis antigens. (90460,90461,90461)
• MMRV (Measles, Mumps, Rubella, and Varicella). Contains 4 components (90460, 90461,90461,90461)

Difference between pediatric IA codes (90460–90461) and non-age specific IA codes (90471-90474)?

The pediatric IA codes (90460 CPT Code and 90461 CPT Code) are distinctly different from the non-age specific IA codes (90471-90474) in several key aspects.

• Pediatric IA codes (90460 CPT Code and 90461 CPT Code) are reported per component and have an age restriction of 18 years and younger. In contrast, the non-age specific IA codes (90471-90474) are reported per immunization (single or combination) with no age restriction.
• Counseling by a physician or other qualified healthcare professional is required for services reported with pediatric IA codes (90460 CPT Code and 90461 CPT Code), whereas counseling is not required for services reported with non-age specific IA codes (90471-90474).
• Pediatric IA codes (90460 CPT Code and 90461 CPT Code) encompass all routes of administration, while the non-age specific IA codes (90471-90474) differ based on the specific route of administration (examples: injectable versus intranasal delivery methods).

These distinctions are crucial for accurately reporting and billing for immunization services provided to pediatric patients versus patients of any age. Understanding these differences is essential for healthcare providers to ensure proper coding and billing practices.

Example for 90460 CPT Code and 90461 CPT Code:

When administering pediatric vaccines, the use of CPT Codes 90460 and 90461 is crucial for accurate reporting and billing. These codes distinguish between the first or only component of a vaccine (90460) and each additional component within a vaccine (90461).

Scenario 1:A pediatric patient aged 4 years comes in for their immunizations. During the encounter, the healthcare provider administers both the DTaP vaccine (which contains diphtheria, tetanus, and pertussis components) and the Varicella vaccine (Chickenpox). In this scenario, you would report 90460 CPT Code for each vaccine administered. So, 90460 for the DTaP vaccine and 90460 for the Varicella vaccine. Additionally, since the DTaP vaccine has multiple components, you would use code 90461 for each additional component beyond the first one. Therefore, you’d also report 90461 for the DTaP vaccine.

Based on the scenario provided, the correct procedure codes to report on the claim for a pediatric patient aged 4 years receiving the DTaP and Varicella vaccines would be as follows:

1. 90700 CPT Code – DTaP Vaccine

2. 90716 CPT Code – Varicella Virus Vaccine

3. 90460 CPT Code (2 units) – Immunization administration code for the first vaccine component in the DTaP vaccine and for the Varicella vaccine

4. 90461 CPT Code (2 units) – Immunization administration code for the two remaining vaccine components in the DTaP vaccine

It’s crucial to ensure accurate reporting of both the vaccine codes and the corresponding administration codes to reflect the services provided during the encounter.