You cannot bill a 90470 and a 90471 together. The instruction that is missing from ost CPT books is that 90470 is an initial code as is the 90471 and the 90472 appends to both. This is due to the fact that most books were published prior to the 90470 being activated in 09. This was later clarified on the AMA website as well as CMS. So if you have 3 vaccines with one being H1N1 then you would have
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