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Medical Billing Rules for Vaccines and Toxoids

It is a common misconception that the administration fee for the injection of vaccines and toxoids should be charged per injection site. The proper method is to charge an administration fee for each component of a vaccine or toxoid. With the high costs of medication, it is important for any physician practice to ensure its costs are covered and that revenue opportunities are not lost. As such, the following serves as a guide for the proper billing of the administration of vaccines and toxoids.

The applicable CPT codes are as follows:

  • 90460 Immunization 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 administered
  • 90461 Each additional vaccine or toxoid component administered

    One component of a vaccine or toxoid would be charged the 90460 administration fee only. Examples include the vaccine for HPV, Influenza, Pneumococcal, Rotavirus, IPV, Hib or Meningococcal, just to name a few.

    The following is an example of a circumstance where multiple components of a vaccine or toxoid would be charged: A five-year old receives a DTaP-IPV IM administration and an MMR/Varicella vaccine SQ administration. The charges on the claim would be:

    • 90460 First component of the DTaP-IPV (Diphtheria)
    • 90461 Second component of DTaP-IPV (Tetanus Toxoid)
    • 90461 Third component of DTaP-IPV (Acellular Pertussis)
    • 90461 Fourth component of DTaP-IPV (Poliovirus)
    • 90460 First component of the MMR/Varicella (Measles)
    • 90461 Second component of MMR/Varicella (Mumps)
    • 90461 Third Component of MMR/Varicella (Rubella)
    • 90461 Fourth component of MMR/Varicella (Varicella)

    It is very important to know which vaccines and toxoids are comprised of multiple components so that you can bill for the administration of those vaccines and toxoids properly. If you are unsure, Precision is here to help you. Please feel free to contact us.