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The CPT® Code 90460 refers to the administration of immunizations for patients who are 18 years of age or younger. This code specifically applies when the immunization is administered through any route, including but not limited to percutaneous, intradermal, subcutaneous, intramuscular, intranasal, or oral methods. A key aspect of this procedure is the counseling provided by a physician or another qualified healthcare professional, which may include physician assistants or nurse practitioners. During the face-to-face encounter, the healthcare provider offers essential information regarding the vaccine or toxoid being administered. This information encompasses the indications for the vaccine, whether it is a single dose or part of a multiple dose schedule, potential side effects, and guidance on which side effects may necessitate medical follow-up. Additionally, the healthcare provider addresses any questions posed by the patient, parent, or family member regarding the vaccine or toxoid. It is important to note that this code is utilized for the first or only component of each vaccine or toxoid administered, while additional components are coded separately using CPT® Code 90461.
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The CPT® Code 90460 is indicated for the administration of vaccines or toxoids to patients aged 18 years or younger. The procedure is performed to provide immunization against various infectious diseases, ensuring that the patient receives the necessary protection as recommended by public health guidelines. The indications for this procedure include:
The procedure for administering immunizations under CPT® Code 90460 involves several key steps, which are detailed as follows:
After the administration of the vaccine or toxoid, the healthcare provider may provide additional instructions regarding post-procedure care. This may include advising the patient or guardian to monitor for any side effects and to seek medical attention if any concerning symptoms arise. The provider may also schedule follow-up appointments if the vaccine requires multiple doses. It is important for the patient or guardian to keep a record of the immunization for future reference and to ensure that the patient receives all necessary vaccinations according to the recommended schedule.
| Short Descr | IM ADMIN 1ST/ONLY COMPONENT | Medium Descr | IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX | Long Descr | 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 | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | 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 | 9 | CCS Clinical Classification | 228 - Prophylactic vaccinations and inoculations |
This is a primary code that can be used with these additional add-on codes.
| 90461 | Addon Code 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; each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure) | 90472 | Add-on Code MPFS Status: Active Code APC N CPT Assistant Article Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) | 90474 | Add-on Code MPFS Status: Active Code APC N CPT Assistant Article Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) |
| 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. | CG | Policy criteria applied | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | KX | Requirements specified in the medical policy have been met | SL | State supplied vaccine | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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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. |
| 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 | Note: AMA Guideline changed. These codes have been deleted from the guidelines: 91300-91317. |
| 2023-04-18 | Note | These codes (previously associated with 90460) 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 change(s) in codebook. |
| 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. |
| 2022-12-08 | Note | AMA Guideline changed. 91316 received FDA approval. |
| 2022-11-16 | Note | AMA guideline changed to include 91316 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2022-10-12 | Note | AMA Guideline changed. 91315 received FDA approval. |
| 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 | Note | First appearance of 2020-2021 AMA guideline changes in codebook. |
| 2021-10-29 | Note | AMA Guideline changed. 91305 & 91307 received FDA approval. |
| 2021-10-20 | Note | AMA Guideline changed. 91306 received FDA approval. |
| 2021-10-06 | Note | AMA guideline changed to include 91307 effective upon receiving Emergency Use Authorization 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. |
| 2021-02-07 | 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 to include 91302 effective upon receiving Emergency Use Authorization 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 |
| 1991-12-31 | Deleted | Code deleted. |
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