COVID-19 immunization administration and E/M visits

The structure of the vaccines section of CPT® was modified to accommodate COVID-19 vaccine product and immunization administration codes. Working in alignment with the CDC, the CPT Editorial Panel approved unique CPT codes for each coronavirus vaccine as well as administration codes for each of those vaccines.

• For immunization administration other than COVID-19, codes 90460–90474 are reported for the administration of the vaccine, along with the appropriate vaccine/toxoid code (90476–90756) targeting the organism.
  • Of these, only two of the immunization administration codes, 90460 and 90461, include counseling by the physician or other qualified health care professional (QHP) at the time of service, specifically for patients up to and through 18 years of age.
    • Therefore, when codes 90460 and 90461 are reported, it would not be appropriate to separately report an E/M visit code for the vaccine counseling.
    • Only if there is a separately identifiable E/M service performed outside of vaccine counseling and immunization administration may a separate E/M visit code be reported, along with modifier 25: Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service.
• The remaining immunization administration codes (90471–90474) may be reported for patients of all ages and do not include vaccine counseling by a physician/QHP.
  • As such, the only immunization administration codes previously available for patients 19 years and older were codes that did not include vaccine counseling.
  • Therefore, when counseling was provided by a physician/QHP to a patient 19 years and older at the time of immunization administration, it was appropriate to separately report an E/M visit code for the vaccine counseling.

When administering the new COVID-19 vaccines, only the immunization administration code (0001A, 0002A, 0011A, 0012A, 0021A, 0022A, 0031A, etc.) specific to the product and dose in the series needs to be reported at this time.

• The COVID-19 vaccine product codes (91300, 91301, 91302, 91303, etc.) do not require reporting currently.
• All COVID-19 immunization administration codes include vaccine counseling, when performed, by the physician/QHP and are not age-specific; therefore, no E/M visit codes may be additionally reported unless a separately identifiable service is performed.
• In this case, the appropriate E/M visit code would be reported with modifier 25 appended. If the only service provided is COVID-19 immunization administration and related vaccine counseling, no other code besides the appropriate administration code may be reported. Counseling may not be required, but if performed, is included in the administration code.

For a current listing of COVID-19 vaccine product and administration codes, please visit, Appendix Q: COVID-19 Vaccines.