Understanding the intricacies of vaccine coding is crucial for ensuring accurate payment and financial health in pediatric practices.
COVID Vaccine Products
Coding for Services Related to COVID-19 Vaccines and Immunization Administration
Vaccine Product and Administration:
The CPT Editorial Panel has developed several SARS-CoV-2 vaccine product codes, as well as a single code for immunization administration. The CPT codes clinically distinguish each coronavirus vaccine product and the specific dose for better tracking, reporting, and analysis. The CPT codes for the administration include:
- practice expense costs of storage and ordering
- counseling provided to patients or caregivers on the date the vaccine is administered
- administering the vaccine
- updating the electronic health record and the vaccine registry
COVID Vaccine Counseling and Administration
Standalone Vaccine Counseling
There may be occasions when a patient or parent presents to their medical home for vaccine counseling, particularly for the COVID-19 vaccine. Increasing vaccine hesitancy surrounding this vaccine may be greater, and some older adolescents may seek out information on their own. For patients and caregivers who opt not to vaccinate after receiving counseling, specific coding options are available. Note that if you provide vaccine counseling on the same day you administer the vaccine to the patient, you may not report counseling separately, as code 90480 is valued to include counseling.
Option 1
If separately identifiable services related to illness are provided in the office, you would report an E/M from code range 99202-99215 based on MDM or total time, add a 25 modifier, and report the counseling based on documented time relating to counseling with code range 99401-99404. If you report an E/M based on total time, the time statement must accurately reflect the specific amount of time spent on each service.
Option 2
If separately identifiable services related to an illness are provided, you would report an E/M from code range 99202-99215 based on time, add a 25 modifier, and report documented time for the counseling by including it in your time for the illness-related visit.
ICD-10-CM codes:
Z71.85 Encounter for immunization safety counseling
Report additional codes for the reason the vaccine was refused and under immunization status with code range Z28. An ICD-10 resource from the National Center for Health Statistics can assist you in finding the full list of codes in this range.
Vaccine Counseling and Administration
If the entire visit consists of counseling and administration of the vaccine, report one of the appropriate product codes (91304 or 91318-91322) and the administration code 90480, which was valued to include the work of vaccine counseling.
Problem related E/M visit for a separately identifiable illness would report the appropriate codes from range 99202-99215, add a 25 modifier, an appropriate product code, and 90480 for administration and counseling for the vaccine.
Periodic preventive E/M codes from range 99381-99384 (new patient) or 99391-
99394 (established patient), add a 25 modifier, an appropriate product code, and 90480 for administration and counseling for the vaccine.
The entire list of pediatric vaccines can be found on the AAP vaccine coding table.
ICD-10-CM codes:
Z23 Encounter for immunization.
CPT Coding Vignettes
Vignette 1
A 6-year-old patient presents 2 days after their periodic preventive visit for administration of the COVID-19 vaccine. The patient receives their first Pfizer 2025/2026 COVID-19 vaccine of 10 mcg/0.3 ml dosage.
Report CPT codes:
91319 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein,10 mcg/0.3 ml dosage, tris sucrose formulation, for IM use
90480 Immunization administration by IM injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVI D-19]) vaccine, single dose
Vignette 2
A 7-year-old patient presents for the administration of a COVID-19 vaccine. The physician counsels the parent on the risks and benefits of receiving COVID-19 vaccine. All of the parents' questions are documented and answered. The parent declines the COVID-19 vaccine.
Report CPT codes:
99401-99404 Preventive Medicine Counseling: based on time spent counseling
Vignette 3
A 13-year-old established patient presents for a well-child visit. A preventive service is provided, including documentation of the child's BMI and counseling for healthy diet and exercise. The physician also counsels for immunization against COVID-19. The patient previously had one dose of a Moderna bivalent COVID-19 vaccine. The Moderna 2025/2026 vaccine of 50 mcg/0.5 mL dosage is administered at the encounter.
Report CPT codes:
99394 Periodic comprehensive preventive medicine reevaluation and management of an individual, established patient; adolescent (age 12 through 17 years), and include a 25 modifier
91322 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 50 mcg/0.5 mL dosage, for IM use.
90480 Immunization administration by IM injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVI D-19]) vaccine, single dose
Vignette 4
A 16-year-old established patient presents for management of ADHD. Before the end of the visit the physician counsels the parent on the risks and benefits of being vaccinated for COVI D-19. The parent agrees with vaccinating their child and the patient receives a 5 mcg/0.5 ml dose of the 2025/2026 Novavax vaccine.
Report CPT codes:
99212-99215 as appropriate, and include a 25 modifier
91304 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5 mL dosage, for IM use
90480 Immunization administration by IM injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVI D-19]) vaccine, single dose
Coding and Payment Hotline
For coding questions or issues with insurance payers, reach out to AAP staff on the hotline.
Last Updated
09/12/2025
Source
American Academy of Pediatrics