Confused about vaccine administration services?

Per CPT guidelines, you may only report one “initial” vaccine administration code per day, regardless of the route of administration. Simple, straightforward, and easy to understand…right? 

Vaccine administration CPT codes 90465, 90467, 90471 and 90473 all reflect initial administration codes and cannot be billed together on the same date of service. NCCI edits apply, and appending modifier -59 to bypass the NCCI edits is not allowed.

But what’s missing from the CPT guidelines? New CPT 90470, H1N1 administration, is not currently reflected in the 2010 CPT books, but must be taken into consideration.  Even among “initial” administration codes there exists a hierarchy for reporting procedures. When CPT 90470 is billed, this trumps all other “initial administration” codes.  Note: CPT 90470 is not reflected in the NCCI edits at this time.

The hierarchy for “initial” vaccine administration reporting is as follow:

1)      90470

2)      90465

3)      90467

4)      90471

5)      90473

When any one of the initial administration codes is billed, all additional immunization administration services provided on the same date must be reported with the appropriate add-on code (90466, 90468, 90472 or 90474).  Did you perform 90470?  If no, did you perform 90465?  If no, did you perform 90467... and so on, until you find your “initial” vaccine administration code.

When billing for multiple vaccine administrations, make sure to report each vaccine administration code on a separate line with only one unit, along with the appropriate diagnosis code for the vaccine given.

Written by: Sandra Inocencio, RN, CPC, CCP