# 90460 +90461



## CodingMari (Aug 10, 2017)

I attended a webinar for Sanofi and they they were actually explaining how to bill and get reimburse for VCF vaccines. 

so example MMR vaccine would be billed as follows;
90707 (3 components)
90460 x2
90461 x1

and other example 
90697 (6 components)
90460 x1
90461 x5

so we are getting paid base on the components of the vaccine? So my provider thinks  if we give 1 vaccine we would bill for 1 administration code and 1 vaccine regardless of the components.

i need clarification maybe examples please help


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## HangarPilot (Aug 10, 2017)

You are correct. 90460 for vaccine counseling for the shot (or first component if there's more than one) and 90461 for each additional component.

MMR would have 2 additional components, Tdap would have +2, DTaP +2, etc.

If a patient received 2 vaccines, DTaP-IPV (Kinrix or Quadracel) and MMRV (ProQuad) you would bill:
90696
90710
90460x2 (first component of each shot)
90461x6 (because each vaccine has 3 additional components)

You definitely want to bill these with commercial insurances. However, when it comes to the Vaccines for Children (VFC) program and the Medicaid HMOs, you will not get paid for them. Since the vaccines are "free" (paid for by the CDC) all you get paid is a flat fee for "administration" of the vaccine which includes any counseling.  If you bill MMR + 90460 + 90461x2 ... they will deny both vaccine counseling codes and pay you $10 for the vaccine itself. Personally I think they should deny the vaccine and pay $10 for the 90460 ... but my opinion doesn't count.


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## MP555 (Oct 17, 2017)

*90460,90461*

If you have 90633 single 90460 next 90713 is that a 90460 or 90461. I am getting denials stating no add ons as of OCT 1,20127

If you can help?


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## istanstu (Dec 1, 2017)

*What State? Each States MCD  has VFC specific rules*

in SC example our limit no matter how many vaccines given is Max unit 1 per day  90460, and Max units 2 per day 90461 
example: patient received 4 vaccines with counsel vfc guidance states despite components we are to bill (per injection) the following 90460 times 1 injection and 90461 times 2 injections
 90707 $0.00, 
90658 $0.00, 
90633 $0.00
90723 $0.00
in our software we actually key our visits in reverse to guarantee that the admins cross over first with the zero dollars vaccines following because we were told the system only read first six line items and if we keyed claim like this let's say:
em
hgb
lead
admin *1
admin*2
vaccine
__________( imaginary system line break)
vaccine 
vaccine
vaccine

my MCD payer would not reimburse my second admins because they crossed into the system without corresponding zero dollars  vaccine 

example 2
patient received 1 vfc flu vaccine without counsel since sc vfc doesn't process 90471 under age 19 we still bill 1 unit of 90460 with the corresponding zero dollars vaccine. I hope this helps if your question is specifically related to VFC Vaccines and Admins


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