Per the CPT guidelines, if a significant, separately identifiable E/M service (i.e. a preventative medicine service or office/outpatient service) is performed in conjunction with a vaccine, the E/M is to be reported with modifier 25.

Here is the scenario...a provider (MD) performs vaccine counseling on a patient prior to the vaccine administration (the patient is older than 18). The counseling outlines the need for the vaccine, side-effects, and the provider answers questions that the patient has in detail. This is more than what would be included in the vaccine administration codes. The provider does not meet the criteria to report the E/M based on time because this did not occur more than 50% of the visit. The provider would like to use a code from the preventative counseling (99401-99404) for this which I think is correct since the counseling here was for disease prevention.

My question is this, if we report 99401-99404 for the counseling in addition to the vaccine codes, is modifier 25 needed on the 99401-990404 code? This is a preventative medicine service per the CPT guidelines.