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Understanding the
Code Types

Coding and Reporting of Vaccines

In coding for vaccine services, use of CPT* codes and ICD-10 codes should be considered. Please see the following explanation of these code types. [5]

CPT codes are part of the Healthcare Common Procedure Coding System (HCPCS) and generally consist of five-digit numeric codes that identify medical services and procedures. [6] There are two types of CPT codes related to vaccines:

Product Codes

  • CPT codes 90476-90749 identify individual vaccine products and are reported in addition to the vaccine administration codes [6]
    • For Medicare Part B billing (influenza vaccines only): While vaccines are assigned CPT codes for billing purposes, due to a special set of circumstances, Q codes were assigned by the Centers for Medicare and Medicaid Services (CMS) to the individual vaccines included under CPT code 90658 [7]

Administration Codes

  • Administration code 90460 and, when appropriate, the add-on code 90461 are reported only when the physician or other qualified healthcare professional provides counseling during immunization of a patient through 18 years of age [6]
  • Administration codes 90471-90474 are reported for administration of any vaccine not accompanied by counseling with a qualified healthcare professional or for administration of vaccines to patients over 18 years of age [6]
    • For Medicare Part B billing (influenza and hepatitis B vaccines):
      Influenza and hepatitis B vaccine administration use G codes (another type of HCPCS code) as follows [2]:
      • G0008 Administration of influenza virus vaccine
      • G0010 Administration of hepatitis B vaccine
TIP It is important to code vaccine-related administrative services accurately for the purposes of maintaining consistent, complete documentation in the medical records. Such documentation may also be used to support billing claims. [8]

*CPT codes are part of the Current Procedural Terminology (CPT) system published and maintained by the American Medical Association (AMA).
ICD-10 codes are part of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) official coding system used for diagnoses.

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Please note that this website is provided for informational purposes only and is not intended to serve as comprehensive training on medical billing and coding. Additional training on medical coding may be required. The information on this website is believed to be accurate as of the date of publication. Users should independently verify accuracy.

Healthcare providers are responsible for making the ultimate decision on when to use a specific product based on clinical recommendations and how to bill for products and related services rendered. Consult third-party insurers' guidelines for specific information regarding the billing and reporting of services rendered.

You are encouraged to report vaccine adverse events to the US Department of Health and Human Services.
Visit www.vaers.hhs.gov to file a report, or call 1-800-822-7967.

To learn more about the
GSK Vaccines Access Program,
click here.
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