Summary & Overview
CPT 90461: Additional Live Attenuated Vaccine Administration, Pediatric
Headline: CPT code 90461 covers same-visit administration of an additional live attenuated vaccine for patients under 18.
Lead: CPT code 90461 denotes the administration of an additional live attenuated vaccine—by parenteral, oral, intranasal, intramuscular, or intravenous routes—given to a patient up to 18 years of age after a first vaccine is administered. The code captures a specific pediatric vaccine-administration scenario that affects billing during multi-vaccine encounters.
Why it matters: Accurate use of CPT code 90461 matters nationally because pediatric immunization visits frequently involve multiple vaccine administrations in a single encounter. Correct coding supports proper claims adjudication, ensures appropriate vaccine administration capture, and affects reporting for vaccine-related services across payers.
Key payers covered: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: This publication explains the clinical context of CPT code 90461, typical sites of service and service type, common modifiers and payer considerations, and where the code fits in vaccine-administration workflows. It provides benchmarks and policy summaries where available, and highlights administrative implications for billing teams and practice managers.
Data note: Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
CPT code 90461 describes the administration of an additional live attenuated vaccine to a patient up to 18 years of age after the first vaccine has been given. The additional vaccine may be delivered by parenteral, oral, intranasal, intramuscular, or intravenous routes.
Service Type: Administration of an additional live attenuated vaccine during the same visit for pediatric patients (vaccine administration service).
Typical Site of Service: Ambulatory clinic, pediatrician office, public health clinic, school-based health center, or other outpatient settings where pediatric immunizations are provided.
Clinical & Coding Specifications
Clinical Context
A 12-year-old child presents to a pediatric primary care clinic for routine immunizations during a well-child visit. The clinician administers an initial live attenuated vaccine (for example, intranasal live attenuated influenza vaccine or oral rotavirus vaccine) and, per the immunization schedule or clinical indications, administers an additional live attenuated vaccine during the same visit for ongoing protection. The clinical workflow includes verification of patient identity and age (patient must be ≤18 years), review of immunization history and contraindications, obtaining informed assent/consent from the parent or guardian, preparation of the appropriate vaccine formulation (parenteral, oral, intranasal, intramuscular, or intravenous if applicable), administration, observation for immediate adverse reactions (typically 15–30 minutes), and documentation of vaccine product, lot number, site, route, date/time, and provider information. Billing is submitted using 90461 to report the administration of the additional live attenuated vaccine for a patient up to 18 years of age after the first vaccine was administered during the same encounter.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service | Use when a distinct E/M visit is provided in addition to same-day vaccine administration documented separately. |