Insider tip: You can choose between 90465-90468 the same way you choose between 90471-90474
Even though you have to learn four new vaccine administration codes this year, CPT makes your task easier by having 90465-90468 echo 90471-90474's differences.
To decide which new immunization administration code to use, code based on these guidelines:
Pinpoint the Administration Route
You should choose the primary code based on the type of administration. "You can either inject a vaccine or administer it nasally," says Victoria S. Jackson, CEO of Southern Orange County Pediatric Association in California.
The new codes - CPT 90465 and 90467 - mirror the old codes - 90471 and 90473 - in the delivery route that they describe. For an initial vaccine administration of an injection, use either:
When staff initially administer a nasal vaccine, report:
Report the Right Add-on Service
When the patient receives an additional vaccine, CPT breaks the new add-on administration vaccine codes into similar groupings as the old codes.
Jackson says to report additional vaccine administrations as follows. If staff inject more than one intramuscular or subcutaneous vaccine, assign either:
If the patient receives the nasal vaccine as the additional vaccine, use either:
Watch out: After coding the initial vaccine administration, always use add-on codes. Never report two initial vaccine administration codes even if the encounter involves different delivery routes. For instance, a claim should never contain:
90467 and 90465.
90471 and 90473.
Appropriate combinations Jackson indicates include:
90466 in addition to 90465 or 90467.
90468 with 90467 or 90465.
90472 in addition to 90471 or 90473.
90474 with 90471 or 90473.
Warning: A claim should never contain only add-on vaccine administration codes:
90466 and 90468
or 90472 and 90474.
