Coding for Preventive Medicine Visits with Administration of Vaccines on the Same Date of Service

The National Correct Coding Initiative was established by CMS to prevent unbundling and the incorrect or inaccurate billing of a combination of codes. These are also called NCCI or CCI edits. CMS identifies individual services that are components of a more inclusive service and governs the reporting of  combinations of CPT codes on the same date of service.

On January 1, 2013, CMS implemented a CCI edit that relates to preventive medicine services and immunization administration codes.  It was 1 of about 300 changes that affected evaluation and management (E/M) services and vaccine administration. In this edit, the vaccine administration code would supersede the E/M or preventive visit code as the only reimbursable code.

To override this edit and report these two services as significant and separately identifiable, you may attach the 25 modifier to the E/M or Preventive Medicine visit codes, listed below.

• Immunization Administration codes: 90460-90461, 90471-90474
• Preventive Medicine Service codes: 99381-99397

Next Steps

To align and adopt the CCI edits, this CCI edit is scheduled to go-live August 24, 2022.

If you are providing an E/M visit, such as a Preventive Medicine visit, and administer vaccines on the same date of service for the same patient, please append the 25 modifier to the E/M or Preventive Medicine visit code to allow reporting of the 2 separate services.

You may review the following for more information:

• Commercial Reimbursement Policy (PDF)
• Prior Communication - Changes to Correct Coding Initiative (CCI) and Outpatient Code Editor (OCE) Edits for Claims Processing