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    v1.0.28
    OpenPayerBilling CodesTherapeutic, Preventive or Other InterventionsCPT cpt-4040f-pneumococcal-vaccine-immune-response
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    CPT 4040F: Pneumococcal Vaccination Administration or History

    CPT code 4040F documents that a pneumococcal vaccine provoked an immune response or that the patient received the vaccine previously; the code applies when a provider administers pneumococcal vaccination or records prior vaccination status. This represents a vaccination administration/denotes vaccine history service typically provided in ambulatory clinic, primary care, pediatric, or geriatric care settings for children under five, adults over 65, and adults 6–64 with qualifying conditions such as asthma.

    For related coverage guidance, see recent payer policy updates: Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA), Cardiovascular Disease Risk Assessment, Biomarkers for Myocardial Infarction and Chronic Heart Failure.

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    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old patient presents to a primary care clinic for routine preventive care. The clinician reviews the immunization history and documents no prior pneumococcal vaccination in the electronic medical record. After confirming no contraindications (e.g., severe allergic reaction to a prior dose or vaccine components), the nurse administers the pneumococcal vaccine during the visit, documents lot number, route, site, and consent, and updates the immunization registry. The clinical workflow includes pre-vaccination screening, counseling on common side effects, vaccine administration, observation for a short interval for adverse reactions, and documentation for billing. The service is typically provided in outpatient primary care clinics, community health centers, and long-term care facilities for adults aged 65 and older or younger patients with qualifying conditions such as chronic lung disease (e.g., asthma).

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    90460Immunization 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 administeredUse when counseling and vaccine administration for pediatric patients is separately reported; pairs with vaccine product codes for the administered immunogen.
    90461Immunization administration through 18 years of age; each additional vaccine/toxoid (list separately in addition to code for primary procedure)Use when multiple pediatric vaccines are administered during the same encounter.
    90471Immunization administration (intramuscular, subcutaneous, or intradermal); one vaccine (single or first)Report for adult immunizations when a single vaccine is administered and counseling/documentation supports the administration service.
    90472Immunization administration (intramuscular, subcutaneous, or intradermal); each additional vaccine/toxoid (single or first)Report when additional vaccine(s) are administered during the same visit for adults.
    90670Pneumococcal conjugate vaccine, 13-valent, for intramuscular useRepresents the vaccine product code that may be reported in addition to administration codes when this specific pneumococcal vaccine is used.
    90732Pneumococcal polysaccharide vaccine, 23-valent, adult or pediatricRepresents an alternative pneumococcal vaccine product code reported with the administration; selection depends on age and clinical indications.

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207Q00000XFamily Medicine PhysicianFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
    207R00000XInternal Medicine PhysicianA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    261QU0200XUrgent Care Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    207QD0401XDiabetology (Family Medicine) PhysicianA family medicine physician who specializes in diagnosis and management of type 1, type 2, gestational, and atypical diabetes; diabetes complications;…
    146L00000XParamedicAn EMT, Paramedic is an individual trained and certified to perform advanced life support (ALS) in medical emergencies based on individual state board…
    347D00000XTrainAn organization or business licensed to provide passenger train service, including light rail, subway, and traditional services.

    Related Payer Policy Updates

    Specialty: Cardiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA)univerahealthcare2026-10-15
    Cardiovascular Disease Risk AssessmentOscar Health2026-10-01
    Biomarkers for Myocardial Infarction and Chronic Heart FailureOscar Health2026-10-01
    Multiple Procedure Payment Reduction for Diagnostic Cardiovascular ProceduresBlue Cross Blue Shield - Maine2026-10-01
    Cardiovascular Disease Risk Assessmentblue cross blue shield - louisiana2026-09-15
    Cardiovascular Disease Risk AssessmentBlue Cross Blue Shield - New Mexico2026-09-04
    Computed Tomography to Detect Coronary Artery CalcificationBluecross Idaho2026-09-01
    Intracoronary Drug Delivery Balloon ProceduresBlue Cross Blue Shield - Rhode Island2026-09-01
    Cardiac Imaging Guidelinesevicore2026-09-01
    Percutaneous Left Atrial Appendage Closure Device for Stroke PreventionAmbetter Georgia2026-08-26

    Related Codes

    CPT-4000F-ASTHMA-TOBACCO-EXPOSURE-COUNSELING

    CPT 4000F: Asthma-Related Tobacco Exposure and Counseling

    CPT-4001F-ASTHMA-TOBACCO-EXPOSURE-SMOKING-CESSATION-MEDICATION-DISCUSSION

    CPT 4001F: Asthma Patient Tobacco Exposure and Smoking Cessation Discussion

    CPT-4003F-UNDEFINED-MEASURE

    CPT 4003F: Preventive Counseling or Risk-Factor Intervention

    CPT-4004F-TOBACCO-USE-SCREENING-AND-CESSATION-OFFER-ADULT

    CPT 4004F: Tobacco Use Screening and Offer of Cessation for Adults

    CPT-4005F-UNKNOWN-SERVICE

    CPT 4005F: No Summary found

    CPT-4008F-UNKNOWN-SERVICE

    CPT 4008F: No Summary available

    CPT-4010F-ACE-INHIBITOR-ARB-THERAPY-DOCUMENTATION

    CPT 4010F: ACE Inhibitor or ARB Therapy Prescribed or Current

    CPT-4011F-ANTIPLATELET-THERAPY-PRESCRIPTION-MANAGEMENT

    CPT 4011F: Prescription for Antiplatelet Therapy

    CPT-4012F-UNCATEGORIZED-PROCEDURE

    CPT 4012F: No Summary Available

    CPT-4013F-STATIN-THERAPY-PRESCRIPTION-OR-CURRENT-USE

    CPT 4013F: Statin Therapy Prescription or Current Use

    Showing 1–10 of 175

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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