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The CPT® Code 90461 refers to the administration of immunizations for patients who are 18 years of age or younger. This code specifically applies when additional vaccine or toxoid components are administered during a single encounter. The procedure involves a face-to-face interaction with a physician or another qualified healthcare professional, such as a physician assistant or nurse practitioner. During this encounter, the healthcare provider offers comprehensive counseling to the patient, their parent, or a family member regarding the vaccine or toxoid being administered. This counseling includes critical information about the indications for the vaccine, whether it is a single dose or part of a multi-dose schedule, potential side effects, and guidance on which side effects may necessitate medical follow-up. The administration of the vaccine or combination vaccine/toxoid can occur through various routes, including percutaneous, intradermal, subcutaneous, intramuscular, intranasal, or oral methods. It is important to note that CPT® Code 90460 should be used for the first or only component of each vaccine or toxoid administered to a patient under 18 years of age, while CPT® Code 90461 is designated for each additional component administered during the same visit.
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The indications for the administration of immunizations using CPT® Code 90461 include the following:
The procedure for administering immunizations under CPT® Code 90461 involves several key steps:
Post-procedure care following the administration of vaccines or toxoids under CPT® Code 90461 includes monitoring the patient for any immediate adverse reactions, which may occur shortly after vaccination. The healthcare provider should advise the patient or guardian on potential side effects and when to seek medical attention if necessary. Additionally, it is important to provide information on any follow-up doses required for the vaccine series and to ensure that the patient's immunization records are updated accordingly. Proper documentation of the immunization in the patient's medical record is also essential for future reference and compliance with public health guidelines.
| Short Descr | IM ADMIN EACH ADDL COMPONENT | Medium Descr | IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT | Long Descr | Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Code Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill Type (12x/13x) | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | O1G - Immunizations/Vaccinations | MUE | 8 | CCS Clinical Classification | 228 - Prophylactic vaccinations and inoculations |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 90460 | MPFS Status: Active Code APC B 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 |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | SL | State supplied vaccine | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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Date
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Action
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Notes
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| 2025-01-01 | Note | First appearance of guideline changes in codebook. |
| 2024-01-01 | Note | First appearance of updated 2022 guideline changes in codebook. |
| 2023-11-01 | Note | AMA guideline changed to include 91304, 91318, 91319, 91320, 91321, 91322 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2023-11-01 | Note | AMA Guideline changed. These codes have been deleted from the guidelines: 91300-91317 |
| 2023-04-18 | Note | These codes (previously associated with 90461) are no longer authorized for use in the United States: 91300, 91301, 91305, 91306, 91307, 91308, 91309, and 91311 |
| 2023-01-01 | Note | First appearance of guideline change(s) in codebook. |
| 2022-12-08 | Note | AMA Guideline changed. 91316 received FDA approval. |
| 2022-12-08 | Note | AMA guideline changed to include 91317. Published to website 2021-12-09. Received FDA approval effective retroactively to 2022-12-08. |
| 2022-11-16 | Note | AMA guideline changed to include 91316 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2022-08-31 | Note | AMA guideline changed. 91312, 91313 received FDA approval effectively immediately. |
| 2022-08-31 | Note | AMA guideline changed to include 91312, 91313, 91314, 91315 effective upon receiving Emergency Use Authorization or approval from the FDA |
| 2022-07-13 | Note | AMA Guideline changed. 91304 received FDA approval. |
| 2022-06-17 | Note | AMA Guideline changed. 91308 & 91311 received FDA approval. |
| 2022-05-19 | Note | AMA guideline changed to include 91311 effective upon receiving Emergency Use Authorization or approval from the FDA |
| 2022-04-26 | Note | AMA guideline changed to include 91310 effective upon receiving Emergency Use Authorization or approval from the FDA |
| 2022-03-29 | Note | AMA Guideline changed. 91309 received FDA approval. |
| 2022-03-07 | Note | AMA guideline changed to include 91309 effective upon receiving Emergency Use Authorization or approval from the FDA |
| 2022-02-01 | Note | AMA guideline changed to include 91308 effective upon receiving Emergency Use Authorization or approval from the FDA |
| 2022-01-01 | Added | First appearance of 2020-2021 AMA guideline changes in codebook. |
| 2021-10-29 | Note | AMA Guideline changed. 91305 and 91307 received FDA approval. |
| 2021-10-20 | Note | AMA Guideline changed. 91306 received FDA approval. |
| 2021-10-06 | Note | AMA Guideline changed. 91307 will be effective upon receiving EUA or approval from the FDA. |
| 2021-09-03 | Note | AMA guideline changed to include 91305 & 91306 effective upon receiving Emergency Use Authorization or approval from the FDA |
| 2021-05-04 | Note | AMA guideline changed to include 91304 effective upon receiving Emergency Use Authorization or approval from the FDA |
| 2021-02-27 | Note | AMA Guideline changed. 91303 received FDA approval. |
| 2021-01-19 | Note | AMA guideline changed to include 91303 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2020-12-18 | Note | AMA Guideline changed. 91301 received FDA approval. |
| 2020-12-17 | Note | AMA Guideline changed. 91302 will be effective upon receiving EUA or approval from the FDA. |
| 2020-12-11 | Note | AMA Guideline changed. 91300 received FDA approval. |
| 2020-11-10 | Note | AMA guideline changed to include 91300 & 91301 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2012-01-01 | Changed | Description Changed |
| 2011-01-01 | Added | Added |
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