Pediatric Coding Alert

Question: When the same physician gives multiple vaccines at the same encounter, should I append modifier 51 to each additional vaccine (after the first vaccine)? Does the modifier result in additional reimbursements?

Coding 911 E-Mail Discussion Group Subscriber

Answer: You do not need to use modifier 51 on additional vaccine products. "When multiple procedures, other than E/M services, physical medicine and rehabilitation services, or provision of supplies (e.g., vaccines), are provided at the same session by the same provider, the primary procedure or service may be reported as listed," according to CPT Appendix A. In other cases, you may add modifier 51 to the additional procedure(s) or service(s).

Warning: Modifier 51 may actually reduce payment for multiple procedures. Medicare pays multiple procedures at 50 percent and private payers may also apply this payment reduction. You may not even have to add the modifier for this to occur. For instance, Medicare carriers automatically apply the reduction when the system detects an appropriate combination.

This reduction is inappropriate for vaccine products. The reduction is supposed to account for overlapping work, such as two surgeries using the same incision.