Coding for Vaccinations
ICD-10-CM Diagnosis Codes for Vaccination Services
The diagnosis codes for an encounter for vaccinations are found in the Z code category (Factors Influencing Health Status and Contact With Health Services) of ICD-10-CM. If a patient is being seen for a specific disease or symptom, report the code for the disease or symptom as well as a code for the vaccination.
Diagnosis codes used for vaccinations are categorized as follows:
- Individuals with potential health hazards related to communicable diseases, including patients who have been exposed to or had contact with someone with a communicable disease
- Encounters for inoculations and vaccinations, including prophylactic administra- tion of vaccines
- Encounters during which a planned immunization was not carried out
The diagnosis codes most likely to be reported when vaccinations are administered to individuals with potential health hazards related to communicable diseases are listed as follows (excludes: carrier of infectious disease [Z22.-*], diagnosed current infectious or parasitic disease [Z22], and personal history of infectious and parasitic diseases [Z86.1-*]):
- Z20 Contact with and (suspected) exposure to communicable diseases
- Z20.1 Tuberculosis
- Z20.3 Rabies
- Z20.4 Rubella
- Z20.82 Contact with and (suspected) exposure to other viral communicable diseases
- Z20.820 Varicella
- Z20.828 Other viral communicable diseases
- Z20.81-* Other bacterial communicable diseases
- Z20.811 Meningooccus
- Z20.9 Unspecified communicable diseases
- Z23 Encounter for immunization
- Z51.89 Encounter for other specified aftercare (Includes: isolation)
- Z41.8 Encounter for other procedures for purposes other than remedying health state (Includes administration of Immune sera [gamma globulin] RhoGAM, antivenin, and tetanus antitoxin)
Immunization not carried out and underimmunization status:
- Z28 Immunization not carried out and underimmunization status
- Z28.0 Immunization not carried out because of contraindication
- Z28.01 Immunization not carried out because of acute illness of patient
- Z28.02 Immunization not carried out because of chronic illness or condition of patient
- Z28.03 Immunization not carried out because of immune-compromised state of patient
- Z28.04 Immunization not carried out because of patient allergy to vaccine or component
- Z28.09 Immunization not carried out because of other contraindication
- Z28.1 Immunization not carried out because of patient decision for reasons of belief or group pressure
- Z28.20 Immunization not carried out because of patient decision for unspecified reason
- Z28.21 Immunization not carried out because of patient refusal
- Z28.29 Immunization not carried out because of patient decision for other reason
- Z28.81 Immunization not carried out due to patient having had the disease
- Z28.82 Immunization not carried out because of caregiver refusal
Excludes 1: Immunization not carried out because of caregiver refusal because of religious belief (Z28.1) - Z28.83 Immunization not carried out due to unavailability of vaccine can be reported
- Z28.89 Immunization not carried out for other reason
Current Procedural Terminology and Medicare Coding for Vaccinations
Vaccination Procedures
A vaccination procedure has two components: 1) the administration of the vaccine and 2) the vaccine product (drug) itself. The administration may be performed by the obstetrician– gynecologist or other health care provider. When the vaccine drug and the administration are provided by the physician office, report a code for the vaccine and a code for administration of the vaccine.
Codes for Administration of the Vaccine
The administration codes specify the method and route of administration (see Table 1 for CPT codes). Medicare and CPT use the same set of codes to report administration of most vaccines.
Table 1. Current Procedural Terminology Codes for Vaccine Administration (Single or Combination Vaccine/Toxoid)
Code | Method | Route of Administration | Type of Service | Reporting Rules |
---|---|---|---|---|
90460 |
Any route |
Percutaneous, intradermal, subcutaneous, or intramuscular |
Primary |
Report for each vaccine administered. Physician also provides counseling. Patient is 18 years or younger. |
90461 |
Any route |
Percutaneous, intradermal, subcutaneous, or intramuscular |
Each additional |
Report for each additional component in a vaccine in conjunction with 90460. Physician also provides counseling. Patient is 18 years or younger. |
90471 |
Injection |
Percutaneous, intradermal, subcutaneous, or intramuscular |
Primary |
Report only one primary vaccine administration per encounter. |
+90472 |
Injection |
Percutaneous, intradermal, subcutaneous, or intramuscular |
Each additional |
Report for secondary or subsequent vaccine administration. |
90473 |
Intranasal |
Intranasal or oral |
Primary |
Report only one primary vaccine administration per encounter. |
+90474 |
Intranasal or oral |
Intranasal or oral |
Each additional |
Report for secondary or subsequent vaccine administration. |
Current Procedural Terminology Copyright 2018 American Medical Association. All rights reserved.
Medicare requires special HCPCS codes for the administration of influenza, pneumo- coccal, or hepatitis B vaccines (see Table 2). Note that some commercial carriers also accept these HCPCS codes. A summary of these codes follows.
Table 2. Medicare’s Healthcare Common Procedure Coding System Codes for Vaccine Administration
Code | Vaccine | Specific Method | Type of Service |
---|---|---|---|
G0008 |
Influenza |
Injection |
Primary |
G0009 |
Pneumococcal |
Injection |
Primary |
G0010 |
Hepatitis B |
Injection |
Primary |
The G codes are temporary codes used to identify professional health care services that would be reported using a CPT code if one existed or to provide more information.
Report the G code for administration and the applicable CPT code for the vaccine.
There are no specific HCPCS codes for administration of other vaccines. In these cases, Medicare accepts the appropriate CPT code for the vaccine administration.
Codes for the Vaccine Drug Product
Current Procedural Terminology and Medicare use CPT codes 90476–90749 to report the vaccine drugs (see Table 3, Table 4, Table 5, Table 6, and Table 7). Beginning in 2006, CPT has included a symbol in front of a code number to indicate that this vaccine was not approved by the U.S. Food and Drug Administration at the time the CPT book was published. After the vaccine has Food and Drug Administration approval, the code is considered active. The changes in vaccine status are posted at https://www.ama-assn.org/ practice-management/find-coding-resources.
Table 3, Table 4, Table 5, Table 6, and Table 7 summarize coding for vaccines and their administration under CPT and Medicare rules, assuming that patients who are 18 years or younger are not being immunized. If patients younger than 18 years are being immunized and provided with physician counseling, then codes 90460 and 90461 would be used instead of codes 90471 and 90472 for injectable vaccines, and codes 90460 and 90461 would be used instead of codes 90473 and 90474 for intranasal or oral vaccines.
The following are administration codes:
- 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid)
- +90472 Each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure.)
- 90473 Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid)
- +90474 Each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure.)
Vaccine | Code for Vaccine Product | Administration Codes | |
---|---|---|---|
CPT | Medicare | ||
Hepatitis A vaccine (HepA), adult dosage, for intra- muscular use |
90632 |
90471–90472 |
90471–90472 |
Hepatitis A vaccine (HepA), pediatric/adolescent dosage, two-dose schedule, for intramuscular use |
90633 |
90460–90472 |
90471–90472 |
Hepatitis A vaccine (HepA), pediatric/adolescent dosage, three-dose schedule, for intramuscular use |
90634 |
90460–90472 |
90471–90472 |
Hepatitis B vaccine (HepB), adolescent, two-dose schedule, for intramuscular use |
90743 |
90460–90472 |
G0010 |
Hepatitis B vaccine (HepB), pediatric/adolescent dosage, three-dose schedule, for intramuscular use |
90744 |
90460–90472 |
G0010 |
Hepatitis B vaccine (HepB), adult dosage, three-dose schedule, for intramuscular use |
90746 |
90471–90472 |
G0010 |
Hepatitis B vaccine (HepB), adult dosage, two-dose schedule, for intramuscular use |
90739 |
90471–90472 |
G0010 |
Hepatitis B vaccine (HepB), dialysis or immuno- suppressed patient dosage, three-dose schedule, for intramuscular use |
90740 |
90471–90472 |
G0010 |
Hepatitis B vaccine (HepB), dialysis or immuno- suppressed patient dosage, four-dose schedule, for intramuscular use |
90747 |
90471–90472 |
G0010 |
Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use |
90636 |
90471–90472 |
90471–90472 |
Human papillomavirus vaccine types 6, 11, 16, 18 (quadrivalent); three-dose schedule, for intramuscular use |
90649 |
90460–90472 |
90471–90472 |
Human papillomavirus vaccine types 16, 18 (bivalent); three-dose schedule, for intramuscular use |
90650 |
90460–90472 |
90471–90472 |
Human papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), two-dose or three-dose schedule, for intramuscular use |
90651 |
90460–90472 |
90471–90472 |
Meningococcal polysaccharide vaccine, serogroups A, C, Y, W-135, quadrivalent (MPSV4), for subcutaneous use |
90733 |
90460–90472 |
90471–90472 |
Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent (MCV4 or MenACWY), for intramuscular use |
90734 |
90460–90472 |
90471–90472 |
Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use |
90670 |
90460–90472 |
G0009 |
Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use |
90732 |
90460–90472 |
90471-90472 |
Tetanus and diphtheria toxoids adsorbed (Td), preser- vative free, when administered to individuals 7 years or older, for intramuscular use |
90714 |
90460–90472 |
90471-90472 |
Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use |
90715 |
90460–90472 |
90471-90472 |
Varicella virus vaccine (VAR), live, for subcutaneous use |
90716 |
90460–90472 |
90460–90472 |
Varicella-zoster immune globulin, human, for intramuscular use |
90396 |
90460–90472 |
96372 |
Zoster (shingles) vaccine (HZV), live, for sub- cutaneous injection |
90736 |
90471–90472 |
90471–90472 |
Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for intramuscular use |
90750 |
90471–90472 |
90471–90472 |
*Note: Influenza codes are outlined in Table 4. Abbreviation: CPT, Current Procedural Terminology.
Table 4. Coding for Influenza Vaccines
Vaccine (Description) | Code for Vaccine Product | Administration Code |
---|---|---|
Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use |
90630 |
90460–90472 |
Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use |
90653 |
90460–90472 |
Influenza virus vaccine, trivalent (IIV3), split virus, preservative-free, for intradermal use |
90654 |
90460–90472 |
Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use |
90655 |
90460–90472 |
Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use |
90656 |
90460–90472 |
Influenza virus vaccine, trivalent (IIV3), split virus, |
90657 |
90460–90472 |
Influenza virus vaccine, trivalent (IIV3), split virus, |
90658 |
90460–90472 |
Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use |
90661 |
90460–90472 |
Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use |
90662 |
90460–90472 |
Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use |
90672 |
90473–90474 |
Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use |
90673 |
90460–90472 |
Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use |
90674 |
90460–90472 |
Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use |
90682 |
90460–90472 |
Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL, for intramuscular use |
90685 |
90460–90472 |
Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use |
90686 |
90460–90472 |
Influenza virus vaccine, quadrivalent (IIV4), split virus, |
90687 |
90460–90472 |
Influenza virus vaccine, quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use |
90689 |
90460–90472 |
Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use |
90756 |
90460–90472 |
Table 5. Medicare Coding for Influenza Vaccines
Vaccine | Code for Vaccine Product | Administration Code (CPT and Medicare) |
---|---|---|
Influenza virus vaccine, split virus, for intramuscular use (Agriflu) |
Q2034 |
G0008 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria) |
Q2035 |
G0008 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval) |
Q2036 |
G0008 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin) |
Q2037 |
G0008 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone) |
Q2038 |
G0008 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified) |
Q2039 |
G0008 |
Table 6. Vaccines Commonly Administered to Children (Report an Administration Code and a Vaccine Code)*
Vaccine | Code for Vaccine Product | Administration Code (CPT and Medicare) |
---|---|---|
Diphtheria and tetanus toxoids and acellular pertussis vaccine and inactivated poliovirus vaccine (DTaP-IPV), when administered to children 4 through 6 years of age, for intramuscular use |
90696 |
90460–90472 |
Diphtheria and tetanus toxoids and acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenzae b PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTaP-IPV-Hib-HepB), for intramuscular use |
90697 |
90460–90472 |
Diphtheria, tetanus toxoids, acellular pertussis vaccine, Haemophilus influenzae type b, and inactivated poliovirus vaccine, (DTaP-IPV/Hib), for intramuscular use |
90698 |
90460–90472 |
Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine (DTaP-HepB-IPV), for intra- muscular use |
90723 |
90460–90472 |
Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intra- muscular use |
90700 |
90460–90472 |
Diphtheria and tetanus toxoids adsorbed (DT) when administered to individuals younger than 7 years, for intramuscular use |
90702 |
90460-90472 |
Hepatitis B and Haemophilus influenzae type b vaccine (Hib-HepB), for intramuscular use |
90748 |
90460–90472 |
Haemophilus influenzae type b vaccine (Hib), PRP-OMP conjugate, three-dose schedule, for intramuscular use |
90647 |
90460–90472 |
Haemophilus influenzae type b vaccine (Hib), PRP-T conjugate, four- dose schedule, for intramuscular use |
90648 |
90460–90472 |
Measles–mumps–rubella virus vaccine (MMR), live, for sub- cutaneous use |
90707 |
90471–90472 |
Measles–mumps–rubella and varicella vaccine (MMRV), live, for subcutaneous use |
90710 |
90460–90472 |
Poliovirus vaccine, inactivate (IPV), for subcutaneous or intramuscular use |
90713 |
90460–90472 |
Rotavirus vaccine, pentavalent (RV5), three-dose schedule, live, for oral use |
90680 |
90460–90461 |
Varicella virus vaccine (VAR), live, for subcutaneous use |
90716 |
90460–90472 |
Abbreviation: CPT, Current Procedural Terminology.
*Note: Influenza codes are outlined in Table 4.
Vaccine | Code for Vaccine Product | Administration Code |
---|---|---|
Rabies vaccine, for intramuscular use |
90675 |
90460–90472 |
Typhoid vaccine, live, oral |
90690 |
90460–90461 |
Typhoid vaccine, Vi capsular polysaccharide (ViCPs), for intramuscular use |
90691 |
90460–90472 |
Yellow fever vaccine, live, for subcutaneous use |
90717 |
90460–90472 |