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New Pediatric Immunization Administration CPT Codes Starting January 1, 2011

Starting January 1, 2011, there will be new pediatric immunization administration CPT codes as follows:

    90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component

    90461 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component (list separately in addition to code for primary procedure)

Immunization administration codes 90471-90474 will remain unchanged and will continue to be reported for patients 19 years and older, or if there is no counseling performed on the patient or the healthcare professional counseling does not meet state requirements for an "other qualified healthcare professional."

These two new codes replace codes 90465-90468 and are reported based on the number of vaccine components rather than the number of injections/administrations.

Units are based on the description of the CPT code. CPT 90461 is intended to be used for each additional vaccine or component - if multiple combination vaccines are billed, the total components of all additional components will need to be reported under one 90461 code. A component refers to all antigens in a vaccine that prevent disease(s) caused by one organism. Combination vaccines are those vaccines that contain multiple vaccine components. Units submitted for administration of the vaccine should coincide with the components of the vaccine.

For example, claims for the IPV vaccine should be filed with 1 unit of 90460. Claims for Pentacel (DTaP-IPV-Hib) should be filed with 1 unit of 90460 and 4 units of 90461. Following is comparison of the new codes (90460 and 90461) and the codes that they will be replacing (90465-90468):

  New CPT Codes:
90460 and 90461
CPT Codes Being Replaced:
90465-90468
Reported "per" Vaccine component Immunization (single or combination)
Age restriction 18 years and younger Younger than 8 years of age
Counseling Required by physician or other qualified health care professional* Required by physician
Routes of administration All routes of administration Codes differ based on route of administration (eg, injectable vs. intranasal)

*CPT does not define "other qualified health care professional." Refer to state scope of practice laws to determine qualification.