Vaccine codes, such as those for immunizations and related procedures, are subject to frequent updates, especially with the introduction of new vaccines or modifications in billing requirements. The American Medical Association (AMA) updated its CPT code set to reflect vaccine code changes for the 2024-2025. In addition to updated codes for the 2024-2025 influenza season, there are two new vaccine codes for pneumonia and meningitis. As a medical coding outsourcing company we keep up with these changes, ensuring that claims are submitted correctly, preventing reimbursements delays and denials.
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New Vaccine Codes for 2025
- Flu Vaccine Code Updates
The Centers for Disease Control and Prevention (CDC) recommends annual flu vaccinations for everyone aged 6 months and older. Medicare Part B fully covers the seasonal flu shot, ensuring accessibility for beneficiaries. Additionally, Medicare provides coverage for extra flu shots when medically necessary. For instance, patients can receive two flu shots within a calendar year if they fall into two different flu seasons, and Medicare will cover both.
According to the Centers for Disease Control and Prevention (CDC), the updated 2024-2025 flu vaccines are all trivalent and will protect against an H1N1, H3N2 and a B/Victoria lineage virus. The 2025 CPT code book will include the following new and updated flu vaccine codes:
90695: Influenza virus vaccine, H5N8, derived from cell cultures, adjuvanted, for intramuscular use (pending FDA approval)
90661: This code refers to the administration of the high-dose influenza vaccine, which provides enhanced protection against seasonal flu. The term “preservative-free” has been removed from the 90661 code. Effective January 1, the descriptor for 90661 will change to:
90661: Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
This vaccine is specifically formulated for individuals aged 65 and older, addressing their increased vulnerability to severe influenza complications. The use of the high-dose vaccine highlights the importance of customizing vaccination strategies for different age groups to optimize flu prevention.
- New Code for Pneumococcal Conjugate Vaccine
90684: Pneumococcal conjugate vaccine, 21 valent (PCV21), for intramuscular use
CPT code 90684 represents vaccinations that protect against pneumococcal pneumonia and other pneumococcal diseases. The vaccine was FDA-approved on June 20, 2024. Code 90684 become effective on June 17, 2024 and will appear in the CPT code book for the first time in 2025.
- New Code for Meningococcal Vaccine
90624 is a new code for a combination meningococcal vaccine given intramuscularly. This pentavalent vaccine includes components against meningitis types A, C, W, and Y plus recombinant proteins against type B disease.
90624: Meningococcal pentavalent vaccine, Men B-4C recombinant proteins and outer membrane vesicle and conjugated Men A, C, W, Y-diphtheria toxoid carrier, for intramuscular use
- COVID-19 Vaccines
The AMA introduced new CPT codes for COVID-19 vaccines, effective August 22, 2024. These include codes 91318 through 91322, corresponding to vaccines targeting specific Omicron variants. Additionally, CPT code 91304 became effective on August 30, 2024. Administration of these vaccines should be reported using CPT code 90480.
- Other Vaccine Code Changes Effective January 1, 2025
Other vaccination code changes effective January 1 include:
- The deletion of codes for intradermal influenza vaccines.
- The use of 90471 or 90473 for the initial or only immunization administration.
- The use of 90472 and 90474 in addition to initial immunization administration codes.
- CPT code 90683 Respiratory syncytial virus vaccine, mRNA lipid nanoparticles, for intramuscular use, Moderna’s respiratory syncytial virus (RSV) vaccine, received FDA approval on May 31. This code will be published in CPT 2025.
The Centers for Medicare and Medicaid Services (CMS) also updated coding guidance for physicians and practices billing for flu vaccine services.
- ICD-10-CM Code Updates
CMS released the FY 2025 ICD-10-CM updates on October 1, 2024. These include 252 new codes, 36 deletions, and 13 revisions, reflecting ongoing advancements in medical knowledge and technology. Notably, new codes have been added to capture adverse effects related to vaccines and biological substances, such as T50.Z95A for adverse effects of other vaccines and biological substances, initial encounter.
Use Vaccine Administration Codes
A vaccination procedure has two key components: vaccine product and vaccine administration. An administration code should always be reported in addition to the vaccine product code. All vaccines for patients of any age should be coded with ICD-10 code Z23, encounter for immunization. Third party payers may have specific policies and guidelines that might require providing additional information on their claim forms. Given below are the codes for vaccine administration.
One of the following administration codes should be used to report the work of counseling patients or caregivers, administering the flu vaccine, and updating the medical record.
For children (through 18 years of age) the administration codes are:
- 90460: Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered
- 90461: Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered
For adults, the administration codes are:
- 90471: Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
- 90472: Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid)
Each separate administration of single component vaccines and/or first component of a combination vaccine is reported using code 90460.
Documentation Requirements
Healthcare providers administering vaccines must document the date of the vaccine administration, vaccine manufacturer, lot number route, site, and patient demographics in the recipient’s permanent medical record. The provider should ensure that the coding and documentation adheres to all applicable state and federal laws and regulations.
Staying updated with the latest vaccine coding changes for 2025 is essential for ensuring accurate billing, regulatory compliance, and optimal reimbursement. Partnering with professional medical coding services can help healthcare providers navigate these updates seamlessly, minimize errors, and focus on delivering quality patient care. By leveraging expert support, you can streamline your practice’s operations and stay ahead in the ever-evolving healthcare scenario.
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