Pediatric Coding Alert

Question: I just got a denial for a patient who received a nasal flu vaccine and a COVID shot at the same visit. Has something changed in coding rules for same-day vaccines?

AAPC Forum Participant

Answer: For a short time between October 1, 2025, and October 14, 2025, the National Correct Coding Initiative (NCCI) Edits Version 31.3 introduced a change affecting claims for vaccine administrations billed on the same day specifically, which were temporarily being bundled by payers. The list of codes is as follows:

• 90471 (Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid))
• 90473 (Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid))
• 90480 (Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, single dose)

According to the Centers for Medicare & Medicaid Services (CMS), claims that were denied in error are being reprocessed without further action needed from practices at this time and that change was made retroactive to July 1, 2025.

However, when doing further research, it was found that as of the date of this publication, the addition of modifier 59 (Distinct procedural service) was still necessary to avoid a denial when submitting a claim with code 90471 or 90473 billed on the same claim with 90480.

It has also been noted that although the issue was resolved for HCPCS code G0008 (Administration of influenza virus vaccine) being bundled with code 90480, the denial problem remains a real issue for commercial payers.

Donna Walaszek, CCS-P, Billing Manager, Northampton Area Pediatrics, Northampton Massachusetts