Vaccine Counseling and Preventive Care Visits

There is an erroneous belief that the Medicare Resource-Based Relative Value Scale (RBRVS) relative value units assigned to the Preventive Medicine Services (PMS) codes (99381-99397) include all or most of the resources (ie, physician work, practice expense, and professional liability insurance expense) expended in the service of vaccine counseling. While vaccines are typically administered during the course of a PMS visit and remain the most evidence-informed component of such visits, vaccine administration can also occur during non-PMS visits. Therefore, it is imperative that the work of vaccine administration is separately reported in order to appropriately capture the resources expended in providing vaccines.

The Preventive Medicine Service Vaccine History

The vaccine-related component included in every preventive visit is the review of the vaccine history. This comprises collecting information on vaccines and vaccine preventable diseases that the patient has encountered and then comparing it to the Department of Health and Human Services (HHS)/Centers for Disease Control and Prevention (CDC) “Recommended Immunization Schedule.” Doing so then allows the provider to determine which vaccines are required or recommended as part of the PMS medical decision making process. Just as the history and physical examination yield a “well child” diagnosis, so does the patient’s general vaccine history yield a recommendation of “required vaccines.” The PMS component related to vaccines ends at this point.

Counseling on Specific Vaccines

All vaccine counseling services beyond the general vaccine history includes, but is not limited to:

• Obtaining information on potential contraindications to receiving a particular vaccine(s)
• Reviewing/discussing the relevant CDC Vaccine Information Statement(s) (VIS)
• Reviewing/discussing risks and benefits of specific vaccine(s)
• Obtaining informed consent for each vaccine administered
• Addressing all other patient/family concerns and questions related to vaccines and immunization administration

For this reason, when vaccines are given at the time of a preventive medicine service, vaccine counseling must be separately reported from the PMS code so that the provider can be appropriately paid for the work involved in vaccine counseling.

For questions, please contact the AAP Coding Hotline.

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