E/M and Vaccination Codes

You can bill for both an E/M with a vaccination code when the visit warrants it. Guidelines are below:

  • The presenting problem or problems should be minimal

  • Five minutes are spent performing or supervising services such as blood pressure checks

  • There needs to be a diagnosis other than the vaccine itself (Z code) – Rash, reason for vaccine, chronic conditions, etc.

  • These services do not need to be performed by an MD or midlevel, they can be performed by a nurse.

Modifier 25 must be appended to the service and submitted without the vaccine diagnosis code. If done by time, it is a 5 minute visit.

If the patient is coming in strictly for an immunization, and there is no counseling or work up for any other issue or side effect, only the Immunization code should be submitted.

If you are counseling the patient on the immunization itself there are codes for the administration with counseling (they may reimburse at a higher level than the regular admin codes). The codes are: 90460 and 90461.

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