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Coding for the Product & Administration of Influenza Vaccine

   

Providers can code for both the administration of the immunization as well as for the actual vaccine product itself. The Current Procedural Terminology (CPT®) codes used in reporting the influenza vaccine products are:

90655 Influenza virus vaccine, trivalent, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular (IM) use (Afluria, Fluzone No Preservative, Fluvirin, FLUARIX)
90656 Influenza virus vaccine, trivalent, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular (IM) use (Afluria, Fluzone No Preservative, Fluvirin, FLUARIX)
90657 Influenza virus vaccine, trivalent, split virus, when administered to children 6-35 months, for IM use (Afluria, Fluzone)
90658 Influenza virus vaccine, trivalent, split virus, when administered to individuals 3 years and older, for IM use (Afluria, Fluzone, Fluvirin)
90660 Influenza virus vaccine, live, for intranasal use (FluMist)


Some non-Medicare providers are requiring the use of Healthcare Common Procedural Coding System (HCPCS) influenza product codes. Check with your payers prior to use.

​Q2035 Influenza virus vaccine, split virus, when administered to individuals 3 years and older, for IM use (Afluria)
Q2037 ​Influenza virus vaccine, split virus, when administered to individuals 3 years and older, for IM use (Fluvirin)
Q2038 Influenza virus vaccine, split virus, when administered to individuals 3 years and older, for IM use (Fluzone)
Q2039 Influenza virus vaccine, split virus, when administered to individuals 3 years and older, for IM use (not otherwise specified)
 

To code for the act of administering the immunization, the following CPT codes can be used:

​ ​Pediatric Immunization Administration Codes
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
 
Non-Age Specific Immunization Administration Codes
90471 IA, (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid)
+90472 IA; each additional vaccine (single or combination vaccine/toxoid) (List separately to code for primary procedure)
90473 IA, (includes intranasal or oral administration); one vaccine (single or combination vaccine/toxoid)
+90474 IA; each additional vaccine (single or combination vaccine/toxoid) (List separately to code for primary procedure)
 
The pediatric IA code (90460) is reported only when both of the following requirements are met:
  1. The patient must be 18 years of age or younger
  2. The physician or other qualified healthcare professional (refer to state scope of practice laws in your state) must perform face-to-face vaccine counseling associated with the administration (Note: Any clinical staff can do the actual administration of the vaccine.)

If both of these requirements are not met, report a non-age-specific IA code(s) (90471-90474) instead. For more information on the IA codes, please go to Pediatric Immunization Administration Codes.

Code 90460 is reported per immunization administered for the first or only vaccine component within that immunization. Since influenza vaccines contain a single component, you will only report IA code 90460 for the administration and counseling when the appropriate criteria are met. Route of administration does not matter when reporting IA code 90460.

Codes 90472, and 90474 are considered "add-on" codes (hence the "+" symbol next to them). This means that the provider will report 90472/90474 in addition to 90471/90473 if more than one vaccine is administered during a visit. Note that there can only be one "first" administration during a given visit.

Here are examples that may help illustrate the IA codes correct use:

Example #1
A 5-year-old established patient is at a physician’s office for her annual well child exam. The patient is scheduled to receive her third hepatitis B, her fifth DTaP, and the Influenza vaccine. After distributing the VIS and discussing the risks and benefits of immunizations with her parents, the physician administers the vaccines. How do you go about selecting the appropriate code(s) for this service?


Step One: Select appropriate evaluation and management (E/M) code

99393 Preventive medicine service, established patient, age 5-11 years
 

Step Two: Select appropriate vaccine product code(s):

90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), IM use
90700 Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), for use in individuals younger than seven years, IM use
90660 Influenza virus vaccine, live, for intranasal use
 

Step Three: Select appropriate immunization administration code(s):  
Since the patient is under eight years of age, and there was physician counseling, select codes from the pediatric IA code family (90465-90468). Therefore the following IA codes will be reported:

90460

(for the IA of the first Hep B component)
90460

(for the IA of the first DTaP component)
90461 x2 (for the IA of each additional DTaP components)
90460 (for the IA of thethe first live influenza component)
 

 Step Four: Select the appropriate ICD-9-CM (diagnosis) code(s):

The vaccine product CPT code and its corresponding IA CPT code are always linked to the same ICD-9-CM code. When vaccines are administered during a routine well child exam, all vaccine serum and IA codes are linked to ICD-9-CM code V20.2:

CPT ICD-9-CM
99393 V20.2
90744 V20.2
90465 V20.2
90700 V20.2
90466 V20.2
90660 V20.2
90468 V20.2

However, when vaccines are administered at a time other than the routine well child check, you will report the appropriate "need for prophylactic vaccine" code. For a complete listing of vaccine ICD-9-CM codes, consult your ICD-9-CM manual or go here.

Example #2
A 5-year-old presents for a vaccine only visit with the nurse. The patient was in a few weeks prior for her routine well-child check, but the office experienced a shortage of vaccines. Today she is due for her DTaP and MMR booster and her intranasal influenza vaccine. The MA asks about any contraindications to the vaccines, the VIS sheets are given and the vaccines are administered.

CPT ICD-9-CM
M
90700 (DTaP Serum) V06.1
90471 (First IA, injection) V06.1
90707 (MMR Serum) V06.4
90472 (Additional IA, injection) V06.4
90660

(Influenza serum)

V04.81
90474 (Additional IA, intranasal)

V04.81

For those providers enrolled in the VFC program, or when their state provides influenza vaccine, the cost of the vaccine product is not billable to the insurance carrier.

Influenza Immunization Administration in "Flu Clinics"
One way to accommodate increased number of children needing immunizations is to hold "flu clinics" where certain days and time slots are set aside for a nurse to administer the vaccine. The physician is physically present in the office suite and available to answer questions or address complications. However, given the underlying goal of maximizing patient exposure to the vaccine, the typical flu clinic model would only involve the staff nurse in the administration of the vaccine. If a patient attends a flu clinic and receives a vaccine without any complications, you would report the appropriate influenza serum code (90657, 90658, 90655, 90656) and the appropriate vaccine administration code ( 90471, 90473)

Example: Patient presents for his (preservative free) seasonal. The parent is counseled, VIS form is given, consent forms are signed and the vaccines are administered. This is a nurse-only (RN) visit. Code as follows:

CPT ICD-9-CM
90656 (Influenza vaccine serum code, preservative free) V04.81
90471* (Seasonal influenza IA code) V04.81

*It is important to remember that counseling on the part of an "other qualified healthcare professional can lead to the reporting of code 90460, however, the nurse’s credentials have to meet the criteria, check with your individual state scope of practice laws.


When is it Appropriate to Report 99211?

Please see the Committee on Coding and Nomenclature’s position paper on this issue.


The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. This content is for informational purposes only. It is not intended to constitute financial or legal advice. A financial advisor or attorney should be consulted if financial or legal advice is desired.  


CPT Copyright 2012 American Medical Association. All rights reserved.