You Be the Expert: Vaccine Administration Codes

Question: Is anyone using the new category I vaccine administration codes/narratives (90471/90472 [new narrative] and 90473/90474 [new codes]) when submitting claims, or are the HCPCS administration codes G0190, G0191 and G0192 being used?

Arkansas Subscriber


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Answer: On Jan. 16, 2001, the AMA released for early use the category I vaccine administration codes 90471, 90472, 90473 and 90474 (just as it did last July with the G0008, G0009 and G0010 administration codes for influenza, pneumococcal and hepatitis B vaccines). They will appear in the CPT 2002 code book. In general, the AMA publishes codes before they appear in the CPT book, and often HCFA either assigns a Level II code prior to official publication of the numeric codes or continues to use the Level II alphanumeric code.

You can use these codes for claims dating from January 2001. The G0190, G0191 and G0192 HCPCS codes do not have their own APC (N status, which means the service is classified as incidental, packaged into the APC rate, with no additional payment allowed), and 90471 and 90472 with the old narrative did not have their own APC (also N status) so reimbursement will not be affected. However, because HCFA has acknowledged the new numeric codes, it is important to assign the most accurate and appropriate codes and to follow the most up-to-date and current coding rules, even though there is no difference in reimbursement. The HCPCS book states: When both a CPT and a HCPCS Level II code have virtually identical narratives for a procedure or service, the CPT code should be used.

Sandra J. Leonard, CCS, CCS-P
Coding Services Representative, MedQuist Inc.

Editor notes: Facilities and practices often bill for services that might not be allowed to establish a usage pattern for future Medicare consideration. Hopefully, Medicares CPT 2002 will assign a value to the codes with the new narrative.

Payers often take months after release to load new codes into their systems, and will commonly accept a particular code billed to primary insurance but deny it for the secondary. So, whether you submit the new codes at this point depends on your local carrier. Medicare and its HCPCS system recognize the codes; Medicaid and others might not. In the case of payers other than Medicare, use the code that applies and is recognized by the carrier youre billing.

- Published on 2001-05-01