Primary Care Coding Alert

Primary Care Coding:

Take This Advice, Keep Your 2024-25 Winter Vaccine Coding Healthy

Published on Mon Oct 28, 2024

Keep your respiratory virus vaccine administration reporting on point.

Each year, respiratory viruses are responsible for huge numbers of illnesses, hospitalizations, and even deaths in the United States according to the Centers for Disease Control and Prevention (CDC). There are many types of respiratory viruses, including COVID-19, flu, and respiratory syncytial virus (RSV). The good news is there are actions your primary care practitioner (PCP) can take to help protect your patients and their families from health risks caused by these viruses.

Immunizations are a core prevention strategy to lower risk from respiratory viruses. For most people, that means getting a current flu and COVID-19 vaccine. For coders, however, that means keeping track of all the different vaccines that are available, and assigning the appropriate CPT^® codes for both the vaccines and their administration. So, we’ve gathered together all of that information into this handy guide to keep your respiratory virus reporting current for this winter season.

Know How to Code for This Year’s Flu Products

All 2024-2025 seasonal influenza vaccines are trivalent. The following table lists them along with their related CPT^® codes.

2024/2025 INFLUENZA VACCINE CODES

Manufacturer	Product Label Tradename	How Supplied	Age	CPT^® Code
GlaxoSmithKline	FLUVARIX	SYRINGE, 0.5mL	6 months & older	90656
GlaxoSmithKline	FLULAVAL	SYRINGE, 0.5 mL	6 months & older	90656
MedImmune, Inc.	FluMist trivalent	APPLICATOR, 0.2 mL	2 through 49 years	90660
Sanofi Pasteur Inc.	FLUBLOK (RIV3)	SYRINGE, 0.5 mL	18 years & older	90673
	FLUZONE HIGH DOSE	SYRINGE, 0.5 mL	65 years & older	90662
	FLUZONE (IIV3)	VIAL, 5 mL, MULTI-DOSE	6 months & older	90658
		VIAL, 5 mL, MULTI-DOSE	6 through 35 months	90657
		SYRINGE/VIAL, 0.5 mL	6 months & older	90656
Seqirus Inc.	Flucelvax	SYRINGE, 0.5 mL	6 months & older	90661
	Flucelvax	VIAL, 5 mL, MULTI-DOSE	6 months & older	90661
	Afluria	VIAL, 5 mL, MULTI-DOSE	3 years & older	90658
		VIAL, 5 mL, MULTI-DOSE	6 through 35 months	90657
		SYRINGE, 0.5 mL SINGLE	3 years and older	90656
	FLUAD	SYRINGE, 0.5mL	65 years & older	90653

Remember: In addition to the vaccine product, you should always use an administration code. The code you should use for the administration will depend on whether the vaccine is given alone or with other vaccines, the route taken for the administration, and whether counseling occurred. It may also depend on the payer in question.

When coding for influenza vaccination without physician counseling, you’ll use one of the following codes:

90471 (Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid))
+90472 (…each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure))
90473 (Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid))
+90474 (…each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure))

If your PCP provides immunization counseling, you should use 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered)) or +90461(…each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure)).

Note that Medicare has its own, unique influenza immunization administration code. For Medicare patients, you should report G0008 (Administration of influenza virus vaccine).

Use the Correct COVID Codes

You should use the following CPT^® codes to report the different COVID-19 vaccines:

2024/2025 COVID-19 VACCINE CODES

Manufacturer	Product Label Tradename	How Supplied	Age	CPT^® Code
Pfizer	COMIRNATY	30 mcg/0.3 mL	Ages 12 years and older	91320
	Pfizer-BioNTech COVID-19 Vaccine	10 mcg/0.3 mL	Ages 5 through 11	91319
	Pfizer-BioNTech COVID-19 Vaccine	3 mcg/0.3 mL	Ages 6 months through 4 years	91318
Moderna	SPIKEVAX	50 mcg/0.5 mL	Ages 12 years and older	91322
Moderna	Moderna COVID-19 Vaccine	25 mcg/0.25 mL	Ages 6 months through 11 years	91321
Novavax	Novavax COVID-19 Vaccine, Adjuvanted	5 mcg/0.5 mL	Ages 12 years and older	91304

You’ll use a different CPT^® code, 90480 (Immunization administration by IM injection of SARS-CoV-2(coronavirus disease [COVID-19]) vaccine, single dose), to bill for the administration of the COVID-19 vaccine. You can use this CPT^® code regardless of whether the provider has counseled the patient or caregiver about the vaccine.

Note that if your PCP administers the influenza or COVID-19 vaccine in a Medicare patient’s home, you may also report M0201 (Administration of pneumococcal, influenza, hepatitis B, and/or COVID-19 vaccine inside a patient's home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient's home) in addition to the base vaccine administration code. However, you should only bill for the additional in-home payment amount if the sole purpose of the visit is to administer a COVID-19 vaccine. Don’t bill for the additional amount if your PCP provides and bills Medicare for another service in the same home on the same date.

And Get Ready for RSV in Adults …

RSV is a common respiratory virus that usually causes mild, cold-like symptoms. It can cause illness in people of all ages but may be especially serious for infants and older adults.

For adults age 75 and older and adults 60-74 at increased risk of severe RSV, the CDC recommends a single dose of any FDA-approved RSV vaccine. There are several RSV vaccines currently available for adults ages 60 and older:

FALL 2024/2025 RSV VACCINE CODES

Manufacturer	Product Label Tradename	How Supplied	Age	CPT^® Code
GlaxoSmithKline	Arexvy	VIAL, 0.5 mL, reconstituted	60 years & older	90679
Pfizer Laboratories	Abrysvo	VIAL, 0.5 mL, reconstituted	60 years & older	90678
Pfizer Laboratories	Abrysvo	VIAL, 0.5 mL, SINGLE-DOSE	60 years & older	90678
Moderna US, INC.	mRESVIA	SYRINGE, 0.5 mL	60 years & older	90683

When billing for any of the RSV vaccine administrations for adults, you’ll reach for 90471 or +90472 as appropriate.

… and in Kids

There are two options for protection of infants against RSV. The CDC recommends a single dose of RSV vaccine from week 32 through week 36 of pregnancy and preventive antibodies given to infants under 6 months of age. You’ll use the following CPT^® codes to report the vaccine product if delivered during pregnancy.

Manufacturer	Product Label Tradename	How Supplied	AGE	CPT^® Code
Pfizer Laboratories	Abrysvo	VIAL, 0.5 mL, reconstituted	32-36 weeks gestational age	90678
Pfizer Laboratories	Abrysvo	VIAL, 0.5 mL, SINGLE-DOSE	32-36 weeks gestational age	90678

Lastly, in 2023, the Food and Drug Administration (FDA) approved Beyfortus (nirsevimab), the first monoclonal antibody of its kind used to help protect infants and young children against RSV. Your PCP can administer Beyfortus to newborns and infants under 8 months born to mothers who did not get a maternal RSV vaccine. It should be given to babies shortly before the RSV season, or within one week after birth if born during October to March. Some babies with chronic conditions could need Beyfortus in the second year of life.

You should use the following CPT^® codes to report the Beyfortus monoclonal antibody product:

Manufacturer	Product Label Tradename	How Supplied		CPT^® Code
Sanofi Pasteur Inc.	BEYFORTUS	SYRINGE, 0.5 mL	Infants < 8 months, < 5 kg	90380
		SYRINGE, 1 mL	Infants < 8 months, 5 kg+	90381
		SYRINGE, 1 mL	8-19 months, increased risk	90381

In 2024, CPT^® released 2 new codes specifically for reporting the administration and counseling of Beyfortus. The billing of the administration depends on whether the provider counseled the family about the injection. The distinction ensures accurate billing based on the level of service provided during the visit.

You should bill Beyfortus monoclonal antibody administration as follows:

Use 96380 (Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection, with counseling by physician or other qualified health care professional) if the provider counseled the family about the injection during the visit.
Use 96381 (Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection) if no counseling was provided.

The Bottom Line

Vaccines for influenza, COVID-19, and RSV are crucial for public health, especially during the winter months when these illnesses are more prevalent. Together, these vaccines play a vital role in preventing widespread illness, reducing healthcare burdens, and protecting vulnerable populations during the winter season.

Donna Walaszek, CCS-P, Northampton Area Pediatrics, Northampton Massachusetts

Primary Care Coding Alert

Primary Care Coding:
Take This Advice, Keep Your 2024-25 Winter Vaccine Coding Healthy
Keep your respiratory virus vaccine administration reporting on point. Each year, respiratory viruses are responsible [...]