Wiki CPT Codes for Administration of Pediatric Vaccines

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sedel1156

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I need help in deciphering the rules for 90460 and 90461. I understand that 90460 is for the first or only vaccine or toxoid administered. An additional code, 90461, is entered for each additional vaccine or toxoid 'component' administered.

Ex: TDap - 90460 = tetanus + 90461x2 for the remaining two components.

My confusion is that when I bill for 90461, it seems to always get denied as 'not payable under patient's current benefit plan', or 'non-covered service'. What's up with this?

I have heard in the past that we should not be using 90461 at all any longer. Which would make sense as to why it is always denied, at least for me. I want clarification as to how we are to report vaccines with more than one toxoid.

Thank so much!
 
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Thank you Carla. This is how I have been coding the vaccines/administrations for years. I think that it is Medicaid and the Medicaid HMO's that are not covering 90461. The notes on the denials state that this particular code is not in the fee schedule. I was just wondering how other coders deal with this if 90461 is not an accepted procedure code.
I will continue to work through it.
I appreciate your help!
 
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sedel1156 said:
Thank you Carla. This is how I have been coding the vaccines/administrations for years. I think that it is Medicaid and the Medicaid HMO's that are not covering 90461. The notes on the denials state that this particular code is not in the fee schedule. I was just wondering how other coders deal with this if 90461 is not an accepted procedure code.
I will continue to work through it.
I appreciate your help!
Click to expand...
Medicaid reimburses at a minimal rate. So they consider a TDAP as one component.
 
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