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Vaccine and Administration Diagnosis Code Billing Instructions and Claims Submission View All  

Adacel vaccine CPT®a code

CPT code 90715 should be used for Adacel vaccine. This code describes a Tdapb booster vaccine for both adult and adolescent use. The age indication for Adacel vaccine is 11 through 64 years of age.

CPT Code Code Description
90715 Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use

Source: 2012 Current Procedural Terminology

Some Medicaid agencies and private health plans require the use of an 11-digit National Drug Code (NDC), in addition to the CPT code, on all claims for physician-administered products. The NDCs for Adacel vaccine, converted to 11 digits, are:

NDC Code Description
49281-0400-10 Package of 10 single-dose vials (10x1)
49281-0400-15 Package of 5 single-dose syringes (5x1)

Administration codes

The administration of Adacel vaccine must be reported in addition to the vaccine product code (ie, assign the code for the vaccine along with the appropriate code for its administration). Assign the appropriate immunization administration code based on the documentation in the medical record.

To more accurately account for the work and practice expenses associated with the administration of multiple-component (combination) vaccines, such as Adacel vaccine, the American Medical Association has established CPT codes, effective January 1, 2011, for the reporting of childhood and adolescent immunization administration. The new codes are based on the number of components in a vaccine. A component refers to all antigens in a vaccine that prevent disease caused by 1 organism.

To appropriately code for administration of Adacel vaccine in patients through 18 years of age when counseling occurs, bill 1 unit of 90460 and 2 units of 90461. This will account for the 3 components in Adacel vaccine. If no counseling occurs in a patient through 18 years of age, or if the patient is over 18 years of age (with or without counseling), bill the original CPT codes, 90471 or 90472 as appropriate. See the grid below for the definitions of these CPT codes.

CPT Code Code Description
90460 Primary code (first vaccine or toxoid component) – 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 Add-on code (each additional vaccine or toxoid component) – 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 (list separately in addition to code for primary procedure)
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) one vaccine (single or combination vaccine/toxoid)
90472 Each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure)
Source: 2012 Current Procedural terminology

Please note that as of January 1, 2011, the physician counseling vaccine administration codes CPT 90465-90468 will no longer be active codes.

Office or other outpatient services

There are times when a provider may choose to administer Adacel vaccine during the course of a problem-focused visit. In these situations, three codes should be reported: the code for the office visit is reported along with the CPT code for Adacel vaccine (90715) and the appropriate immunization administration code.

  • Office visit code (99201-99215)c
  • Adacel vaccine code (90715)
  • Immunization administration code (90460 and 90461; or 90471; or 90472)c

Preventive medicine codes

Immunizations are often provided during preventive medicine evaluations, often referred to as physical exams or "well visits." In these situations, three codes should be reported: the code for the preventive visits is reported along with the CPT code for Adacel vaccine (90715) and the appropriate immunization administration code.

  • Preventive medicine service code (99381-99397)c
  • Adacel vaccine code (90715)
  • Immunization administration code (90460 and 90461; or 90471; or 90472)c

Diagnosis codes (ICD-9-CM)

Below are suggested diagnosis codes that may be appropriate when submitting claims for Adacel vaccine. Assign the appropriate code based on review of the documentation in the medical record. If Adacel vaccine is administered for a specific wound, injury, or condition, the specific diagnosis code should be reported as well.

ICD-9 Code Code Description Suggested Use
VO6.1 Need for prophylactic vaccination and inoculation against combination of diseases; diphtheria-tetanus-pertussis, combined [DTP] [DTaP] When Adacel vaccine is administered as a prophylactic immunization
ICD-9 code specific to wound or injury To be determined by practitioner When Adacel vaccine is administered for wound care
Source: 2012 International Classification of Diseases, 9th Revision, Clinical Modification, 6th edition.

Billing instructions and claims submission

All timely reimbursement starts with accurate coding and claims submission. The following information is offered to assist you in preparing and appealing claims for Adacel vaccine.

  • Update patient’s demographic and insurance information routinely (this assures accuracy in completing claims); verify spelling
  • Verify each patient’s benefits prior to service
  • Recheck claims for coding accuracy (ie, ICD-9-CM codes are coded to the highest level of specificity, use a fourth or fifth digit as appropriate)
  • File claims in a timely manner to comply with payer time limits
  • Review Remittance Advice (RA) and Explanation of Benefits (EOB) from payers for accuracy
  • Be prepared to appeal any denials with supportive literature
  • Consider other resources to resolve denials, including the patient’s employer group and the patient himself/herself

a CPT = Current Procedural Terminology is a registered trademark of the American Medical Association.
b Tdap = Tetanus, diphtheria, and acellular pertussis.
c Select the appropriate code based on review of documentation in the medical record. To report that the visit is separately identifiable from the vaccine administration service performed on the same day, modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) can be appended to the selected visit code.

These codes are provided for your information only. It is the responsibility of the health-care professional to determine the most appropriate code to use in billing for services rendered. The use of these codes does not guarantee payment.