Immunization administration (includes percutaneous, intradermal, subcutaneous, intramuscular, and jet injection); 1 vaccine (single or combination vaccine/toxoid)
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Vaccine product code missing - administration billed without vaccine supply
Very Common90471 is administration code only - must bill with corresponding vaccine product code (90686 for flu, 90715 for Tdap, etc.). Denials occur when administration code submitted without vaccine supply code, or when vaccine code missing from claim.
Common Causes
- • Only 90471 billed - no vaccine product code submitted
- • Vaccine product code denied separately - administration code also denied
- • State-supplied vaccine (no product code billed) - forgot SL modifier on administration
Resolution Strategy
Submit corrected claim including both: 90471 (administration) + appropriate vaccine product code (90686 for flu vaccine, 90715 for Tdap, 91303 for COVID-19, etc.). Vaccine product and administration are billed separately - both required for complete claim. Include vaccine lot number, manufacturer, and documentation showing vaccine actually administered. If state-supplied vaccine (VFC program), bill administration code 90471 with SL modifier (state-supplied vaccine) - do not bill vaccine product code.
2. Billed with E&M same day without modifier 25 - bundling denial
CommonVaccine administration (90471) may be denied when billed same day as E&M visit without modifier 25 on E&M. Insurance bundles vaccination into well visit unless significant separate E&M service documented and E&M coded with modifier 25.
Common Causes
- • Well-child visit (99391-99394) includes anticipatory guidance and vaccines - 90471 included
- • Sick visit where vaccine also given - E&M needs modifier 25 to show separate service
- • No modifier 25 on E&M code - indicates vaccine was only service
Resolution Strategy
If vaccine given during preventive visit (well-child/well-adult), vaccine administration may be bundled - check payer policy. If vaccine given during sick visit for separate medical problem, resubmit E&M with modifier 25 and include documentation showing significant separate evaluation (e.g., patient seen for URI - also given flu vaccine - E&M for URI evaluation is separate from vaccine administration). Modifier 25 indicates significant separately identifiable E&M service on same day as procedure. Some payers bundle vaccines into preventive visits regardless of separate documentation.
Relative Value Units (RVUs)
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Clinical Information
When to Use
First or only vaccine administration without counseling (any age)
Common Scenarios
Documentation Requirements
- Vaccine administered documented
- Route of administration documented
- Patient response to vaccination
Coding Guidelines
Common Modifiers
Bundling Rules
- First or only vaccine
- No counseling included
- Any age
- May be billed with vaccine product code
Exclusions
- Do not bill with counseling codes if counseling provided
- Do not bill with additional vaccine codes on same vaccine
Coding Notes
Related CPT Codes
Clinical scenarios
- Vaccine administered documented
- Route of administration documented
- Patient response to vaccination
- Vaccine administered documented
- Route of administration documented
- Patient response to vaccination
- Vaccine administered documented
- Route of administration documented
- Patient response to vaccination
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 90471 is the billing code for "Immunization administration (includes percutaneous, intradermal, subcutaneous, intramuscular, and jet injection); 1 vaccine (single or combination vaccine/toxoid)". First or only vaccine administration without counseling (any age)
Medicare pays approximately $20.05 for CPT 90471 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 90471 has a total RVU of 0.44, broken down as: Work RVU 0.17, Practice Expense RVU 0.25, and Malpractice RVU 0.02. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 90471 is "Vaccine product code missing - administration billed without vaccine supply". 90471 is administration code only - must bill with corresponding vaccine product code (90686 for flu, 90715 for Tdap, etc.). Denials occur when administration code submitted without vaccine supply code, or when vaccine code missing from claim. Common causes include: Only 90471 billed - no vaccine product code submitted; Vaccine product code denied separately - administration code also denied. Appeal success rate is approximately 70-80%.
Key documentation requirements for CPT 90471 include: Vaccine administered documented; Route of administration documented; Patient response to vaccination. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 90471: First or only vaccine. No counseling included Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 90471 include: 59 (Distinct procedural service when multiple procedures performed), 25 (Significant, separately identifiable evaluation and management service). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 90471 is Typically 3-5 minutes. Time-based codes require documentation of the actual time spent providing the service.