Billing Administration Codes for Vaccinations

Billing Administration Codes for Vaccinations

Rhode Island Medical Assistance does not reimburse state supplied vaccines. Rhode Island Medical Assistance will reimburse the administration for these vaccines.

• CPT 90460 (immunization administration through 18 years via any route of administration, with counseling by physician) allows one (1) unit.

• CPT 90461(immunization administration through 18yrs via any route of administration, each additional vaccine) allows eight (8) units.

• Vaccines with multiple components are considered as one unit.

• An administration code is allowed for every injection performed.

For example: procedure code 90696 (DTap, Tetanus, Acelullar Pertussis, Polio) has four components; however it is consider as one unit and will be reimbursed as one unit.

If the vaccines are administered with a flu vaccine, RI Medical Assistance will reimburse multiple administrations.



For example: procedure codes 90748 (Hepatitis B), 90680 (Rotavirus vaccine), and 90670 (Pneumococcal Vaccine) are single components.

• Bill one (1) unit of CPT 90460 for the first injection.

• Bill two (2) units of CPT 90461 for the subsequent injections.

Please note: In order to avoid denials for duplicate charges, the units for CPT 90461 must be rolled together and billed on one detail line.