^aA component refers to all antigens in a vaccine that prevent disease caused by 1 organism.

^bCPT (Current Procedural Terminology) is a registered trademark of the American Medical Association.

^c ICD 10 = International Classification of Disease, 10th Revision.

^d When tetanus or rabies products are given as part of clinical management, use a primary ICD-10 code which describes the patient’s condition.

^e Coding for RIG is based on the units administered. Bill a unit of service for each milliliter administered, rounding up or down as appropriate when the milliliters administered are not a whole number. For example, 9.9 milliliters is rounded up and billed as 10 units of service. For NDC reporting, the units dispensed in this example would be ML9.9. Refer to Reimbursement Information on VaccineShoppe.com^® for further assistance.

^f There are 2 possible NDCs for the Hib component of this vaccine. Use the NDC that is on the product you administered.

Some payers require an NDC in addition to the CPT code for the product. In such cases, it is important to format the NDC correctly or the claim will be denied, and you will need to resubmit a corrected claim in order to be reconsidered for payment. The grid on the inside of this guide provides the NDCs for all Sanofi Pasteur products in billing format.

First confirm with your payer if they require the carton NDC, the unit-of-use (vial or syringe) NDC, or if they will accept either. When an NDC is required, enter the following in line 24A of the claim form:

1. Start with qualifier N4, and, with no space, follow immediately with the 11-digit NDC number (no hyphens).
   1. To convert Sanofi Pasteur products to the required 11-digit format, add a leading zero in the middle section of numbers (ex. 49281-545-03 = 49281-0545-03).
2. After a space, follow the NDC with the Unit of Measure and Units Dispensed.
   1. If the product is reconstituted, use Unit of Measure UN followed by the number of units dispensed with no space. Example: UN1 signifies that 1 unit of reconstituted pr oduct was administered.
   2. If the product is supplied in a liquid format, use the Unit of Measure ML, and the Units Dispensed is the actual decimal quantity administered with no space.

The codes used to populate registries are CVX codes, which indicate the product used in a vaccination, and MVX codes, which indicate the manufacturer of the vaccine. When a MVX (manufacturer) code is paired with a CVX (vaccine administered) code, the specific trade named vaccine can be identified.

An immunization administration code must be reported in addition to the vaccine or toxoid product code in order to be paid for the administration service. There are 2 code sets that may be used when billing for administration, depending on the age of the patient and whether or not qualified counseling was performed.

If the patient is 18 years of age or under, and counseling was performed by the physician or other qualified health care professional, component-based administration codes are used. These codes are based on the number of components in the vaccine, and a unit of administration is billed for each component. A component is defined as each disease for which the vaccine is intended to provide protection. These codes apply to all routes of administration, including injectable, intranasal, and oral.

• 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.

Example: IIV4, a single-component vaccine, is administered to a pediatric patient and the physician provides face-to-face counseling. Administration is billed using 1 unit of 90460.

Example: DTaP-IPV/Hib, a 5-component vaccine, is administered to pediatric patient and face-to-face counseling is provided by the nurse practitioner. Administration is billed using 1 unit of 90460 and 4 units of 90461.

If the patient is 19 years of age or over, or if they are 18 years of age or under and qualified counseling was not performed, use the code set that is based on number of vaccinations administered at that visit.

• 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)
• 90473 — Immunization administration by oral or intranasal route; 1 vaccine (single or combination vaccine/toxoid)
• +90474 — Immunization administration by oral or intranasal route; each additional vaccine (single or combination vaccine/toxoid)

Example: IIV4 and Tdap vaccines are administered to an adult patient. Bill 1 unit of 90471 for administering the IIV4 vaccine and 1 unit of 90472 for administering the Tdap vaccine.

If the patient is covered by Medicare Part B you must use codes G0008, G0009, or G0010 when billing for administration of influenza, pneumococcal, or hepatitis B vaccines.

• G0008 — Administration of influenza virus vaccine
• G0009 — Administration of pneumococcal vaccine
• G0010 — Administration of hepatitis B vaccine

Example: IIV4-HD and PCV13 vaccines are administered to a Medicare patient. Bill G0008 for administering the IIV4-HD vaccine and G0009 for administering the PCV13 vaccine.

Verify that you are billing the proper administration code based on the patient encounter. There are different administration codes for different circumstances. Choose the correct code for each circumstance.

The administration code for Imogam Rabies-HT is CPT 96372. Bill one unit for each syringe used. No administration code is billed with Tubersol.

A visit may be billed only if it was for a separate and significant reason, not otherwise related to the product administration. Health plans which follow Correct Coding Initiative (CCI) edits may require that modifier -25 be attached in order to be paid for the visit and the administration service.

Modifier -25 should be attached to the CPT code for the visit and an ICD-10 code(s) which describes the reason for the visit should be used. It is important to use modifier-25 and accurate ICD-10 code(s) for the visit as they support the health plan’s reimbursement for the visit.

As usual, the code(s) for the product and administration should be billed using the appropriate CPT and ICD-10 codes. Modifier -25 is only used with the visit code.