Vaccine and Admin code Billing Guidelines & Medicaid Reimbursement Rate

Admin Code:

• CPT 90460 is reported when the vaccine is administered by a physician after face-to-face counseling with the patient. This code is applicable for patients aged 18 or below 18.

• CPT 90461 is reported when an additional component is given to the patient along with 90460.

• CPT 90471 is reported when the vaccine is administered by a medical assistant or nurse and a physician is not present at all. This code is applicable to patients aged over 18. This code is also reported when a patient's age is over 18 and the vaccine is administered by a physician after face-to-face counseling to the patient.

• CPT 90472 is reported when an additional component is given to the patient along with 90471 or 90473.

• CPT 90473 is reported when a vaccine is administered by a medical assistant or nurse and a physician is not present at all. This code is applicable to patients aged over 18. This code is also reported when a patient's age is over 18 and the vaccine is administered by a physician after face-to-face counseling to the patient. 

• The only difference between CPT 90471 & 90473 is, 

• CPT 90471 is reported when a vaccine is given through injection and CPT 90473 is reported when a drug is given through the nose or mouth.

• CPT 90474 is reported when an additional component is given to the patient along with 90473 or 90471.

Note:

• CPTs 90460, 90471 & 90473 cannot be reported together on the same date of service.

• CPTs 90472 & 90474 can be reported with CPT 90460 if the patient's age is 18 or below 18.

• CPT 90472 can be reported with 90473.

• CPT 90474 can be reported with 90471.

Medicaid reimbursement rate for Admin codes:

• When submitting CPT 90460 to Medicaid, the allowed rate is $21.68.

• When submitting CPT 90461 to Medicaid for additional vaccine then the allowed rate is $0.00.

• When submitting CPT 90471 to Medicaid, the allowed rate is $21.68.

• When submitting CPT 90472 to Medicaid for additional vaccine then the allowed rate is $12.59.

• Note: Even if the Medicaid rate is $0.00, it is necessary to report the vaccine and admin code together, or else the claim gets denied.

Medicaid reimbursement rate for Vaccine codes: