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PAP505

Immunization Billing


Provider Administrative Policy

Section
Physician
Policy Date
November 2007
Status/Date
Revised/June 2012
Provider Type(s)
Physician  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts


Policy

Immunization Billing

If the vaccine is part of the Universal Vaccine Program, submit the appropriate CPT code with modifier SL and a charge of $.00 for each state supplied vaccine administered.

Per CPT, Blue Cross of Idaho will only allow one "Immunization administration (includes single/first/initial immunization administration procedure at a single patient encounter.) If billing for more than one immunization administration code, use the appropriate "each additional" code for the second and subsequent administration charge(s). 

Example:  90471, or 90473 for first vaccine administered.
                 90472, or 90474 for each additional vaccine administered.          

Code 

Description

90460

Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified healthcare professional; first or only component of each vaccine/toxoid component.

90461

Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified healthcare professional; each additional vaccine/toxoid component (list separately in addition to code for primary procedure)

90471

Immunization administration (includes percutaneous, intradermal, subcutaneous, intramuscular injections); one vaccine (single or combination vaccine/toxoid), one unit.

90472

Each additional vaccine (single or combination vaccine/toxoids) (list separately in addition to code for primary procedure.) One or more units, depending on how many vaccines you give.

90473

Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoids) (Do not report 90473 in conjunction with 90471)

90474

Each additional vaccine (single or combination vaccine/toxoids) (list separately in addition to code for primary procedure.) (Use 90474 in conjunction with 90471 or 90473)

90649 HPV vaccine for males age 11-26 has been recommended by the CDC as a routine immunization in Dec 2011. Blue Cross of Idaho Chief Medical Officer has approved for coverage effective 01/01/2012 date of service. State supplied since 07/01/2011.

G0008

Administration of influenza virus vaccine when there is no physician fee schedule service on the same day.

G0009

Administration of pneumococcal vaccine.

G0010

Administration of hepatitis B vaccine.

G9141

Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)

G9142

Influenza A (H1N1) vaccine, any route of administration

BlueCard®
Follow the standard instructions outlined above for BlueCard claims.


Policy History

Date Action Reason
June 2012 Revised Code 90649 noted state supplied since 07/01/11
March 2012 Revised Noted 90470 Deleted code 01/01/12/ added 90949
April 2011 Revised New codes added and deleted. Clinical Editing clarification.
January 2011 Revised New codes added
January 2010 Revised Codes added, H1N1 added
May 2008 Revised Oral codes added

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