CPT 90460Other

Im admin 1st/only component

CPT 90460 is used when a healthcare provider administers a vaccine through injection or nasal spray to a patient under 19 years old, when the vaccine has only one component or is the first component of a multi-component vaccine.

Showing rates for

National Average

Base Medicare rate

$22.32

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.24

PE RVU (NF)

0.43

MP RVU

0.02

Total RVU

0.69

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Always verify patient age is under 19 years at time of service; use 90471 for patients 19+ or when no counseling provided
Impact: Age-inappropriate coding is a top 3 denial reason; correcting before submission prevents 100% of age-related denials worth $22.32 per component
Bill 90460 for first/only component and 90461 for each additional component in multi-antigen vaccines (e.g., MMR has 3 components: 90460 + 90461 + 90461)
Impact: Multi-component vaccines can generate $66.96+ per administration when properly coded (90460 $22.32 + two 90461s at approximately $22.32 each); undercoding loses 60-67% of potential revenue
Document face-to-face counseling in medical record including discussion of risks, benefits, VIS provided, and parent/guardian questions addressed
Impact: Counseling documentation is required element; lack of documentation converts to lower-paying 90471 ($16-18 range), reducing revenue by approximately $4-6 per vaccine or 18-25%
Use modifier SL when billing administration for state-supplied vaccines (VFC program) and bill the administration only, not the vaccine product code
Impact: VFC administration is billable even when vaccine is free; represents $22.32 per component that practices often fail to capture; SL modifier ensures proper payer adjudication
When vaccines are given during E/M visit, append modifier 25 to E/M code and document medical necessity for E/M service separate from vaccine counseling
Impact: Modifier 25 protects full E/M payment averaging $75-150; without it, payers may bundle or deny E/M, losing 70-85% of visit revenue
Verify NDC reporting requirements for vaccine administration; some state Medicaid and managed care plans require NDC on administration line

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Frequently asked questions

What is the difference between CPT 90460 and 90471?

CPT 90460 is used for patients through 18 years of age when physician or qualified healthcare professional provides face-to-face counseling to the patient/family about the vaccine. CPT 90471 is used for patients of any age when counseling is not provided or when the patient is 19 years or older. The 90460 code typically reimburses higher ($22.32 vs approximately $16-18) due to the counseling component requirement.

How many times can I bill CPT 90460 on the same date of service?

Bill 90460 only once per date of service for the first or only vaccine component administered. For multi-component vaccines (like MMR with 3 antigens), bill 90460 for the first component and 90461 for each additional component. If administering multiple separate vaccines, bill 90460 once for the first component of the first vaccine, then use 90461 for all remaining components across all vaccines given that day.

Can I bill 90460 with an E/M code on the same day?

Yes, you can bill both when a significant, separately identifiable E/M service is performed on the same day as vaccine administration. Append modifier 25 to the E/M code and document the medical necessity for the E/M service separate from the vaccine counseling. For example, a sick visit for ear infection where routine vaccines are also given would support both codes.

What documentation is required to support billing CPT 90460?

Required documentation includes patient age verification (under 19), vaccine details (name, manufacturer, lot, expiration, site, route), VIS publication date provided, and explicit documentation of face-to-face counseling by physician or QHP. The counseling note must show discussion of vaccine risks, benefits, contraindications, and any parent/guardian questions addressed. Simply noting 'VIS given' is insufficient.

How do I bill vaccine administration for VFC (Vaccines for Children) program patients?

For VFC patients, bill only the administration code (90460/90461) with modifier SL, not the vaccine product code. The vaccine itself is provided free through the VFC program, but the administration service is billable to Medicaid or the patient's insurance. Ensure VFC eligibility is documented and that you're enrolled as a VFC provider before submitting claims.

What are the RVUs for CPT 90460 in 2025?

For 2025, CPT 90460 has total RVUs of 0.69, consisting of 0.24 work RVU, 0.43 practice expense RVU (both facility and non-facility), and 0.02 malpractice RVU. With the 2025 conversion factor of 32.3465, this results in a Medicare national average payment rate of $22.32 for both facility and non-facility settings.

What happens if I use CPT 90460 for a patient who is 19 years old or older?

Using 90460 for patients age 19+ will result in claim denial for age-inappropriate coding. You must use CPT 90471 (first component) and 90472 (each additional component) for adult patients regardless of whether counseling is provided. Review the patient's date of birth before coding, and if a claim is denied for age, resubmit with the correct adult administration codes along with birthdate documentation.