Summary & Overview
CPT 90460: Pediatric Immunization Administration with Counseling
CPT code 90460 represents the administration of immunizations to patients up to 18 years of age, with counseling provided by a physician or other qualified health care professional. This code is nationally significant as it supports preventive care efforts and ensures proper documentation and billing for pediatric immunizations, which are a cornerstone of public health. The code is applicable for the first or only component of each vaccine or toxoid administered during an office visit, typically in outpatient pediatric settings.
Major payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. Understanding how these payers process claims for CPT 90460 is crucial for providers and billing professionals seeking to optimize compliance and reimbursement.
Readers will gain insights into the clinical context of immunization administration, relevant policy updates, and coding benchmarks. The publication also addresses common modifiers, associated taxonomies, and related CPT codes, providing a comprehensive overview of the billing landscape for pediatric immunizations. This information is vital for healthcare organizations, clinicians, and billing teams aiming to stay current with national standards and payer requirements.
CPT Code Overview
CPT 90460 is used to report immunization administration for patients through 18 years of age, via any route of administration, when counseling is provided by a physician or other qualified health care professional. This code applies to the first or only component of each vaccine or toxoid administered during the encounter. The service type is Medicine – Immunization administration, and it is most commonly performed in an office setting, such as an outpatient pediatric clinic. This code is essential for documenting and billing immunization services that include counseling, ensuring accurate reimbursement and compliance with clinical guidelines.
Clinical & Coding Specifications
Clinical Context
A child under 18 years of age presents to a pediatrician's office for a routine well-child visit. During the encounter, the physician or other qualified health care professional provides counseling to the patient and/or their guardian regarding recommended immunizations. Following the counseling, the provider administers the first or only component of a vaccine or toxoid. The service is performed in an outpatient setting, such as an office (Place of Service 11). This scenario typically involves documentation of both the counseling and the administration of the immunization.
Coding Specifications
- Modifier
‑25: Used when a significant, separately identifiable evaluation and management (E/M) service is performed by the same physician on the same day as the immunization administration. Commonly reported with a well-child E/M visit.
| Provider Taxonomy Code | Specialty Name |
|---|---|
208000000X | Pediatrics |
207Q00000X | Family Medicine |