Vaccine codes, including those for immunizations and related procedures, are frequently updated, especially when new vaccines are introduced or billing requirements change. The American Medical Association (AMA) has updated the CPT code set to reflect these changes for the 2024-2025 period. In addition to updates for the influenza season, two new vaccine codes have been introduced for pneumonia and meningitis.
New Vaccine Codes for 2025
Flu Vaccine Code Updates: The Centers for Disease Control and Prevention (CDC) recommends annual flu vaccinations for individuals aged 6 months and older. Medicare Part B fully covers the seasonal flu vaccine, ensuring accessibility for eligible beneficiaries. Medicare also covers additional flu shots if medically necessary. For example, a patient may receive two flu shots in one calendar year if they fall under two different flu seasons, and Medicare will cover both.
For the 2024-2025 flu season, the CDC has recommended trivalent flu vaccines that protect against H1N1, H3N2, and the 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: The high-dose influenza vaccine, designed for individuals aged 65 and older, has had the term “preservative-free” removed. The new description, effective January 1, 2025, will read:
- 90661: Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, antibiotic-free, 0.5 mL dosage, for intramuscular use.
This vaccine provides enhanced protection for older individuals, who are at greater risk for severe complications from influenza.
New Codes for Pneumonia and Meningitis Vaccines:
90684: Pneumococcal conjugate vaccine, 21 valent (PCV21), for intramuscular use. This code applies to vaccines that protect against pneumococcal diseases and will be effective starting June 17, 2024.
90624: A new code for the meningococcal pentavalent vaccine, which includes protection against meningitis types A, C, W, Y, and type B. This vaccine is given intramuscularly.
COVID-19 Vaccine Updates:
The AMA has introduced new CPT codes for COVID-19 vaccines, effective August 22, 2024, including codes 91318-91322, which correspond to vaccines targeting specific Omicron variants. Additionally, CPT code 91304 will be effective starting August 30, 2024. The administration of these vaccines should be reported using CPT code 90480.
Other Vaccine Code Changes (Effective January 1, 2025):
- The deletion of codes for intradermal influenza vaccines.
- Codes 90471 and 90473 will be used for the initial or only immunization administration.
- Codes 90472 and 90474 will be used for additional immunization administrations.
Additionally, CPT code 90683 will be added for Moderna’s respiratory syncytial virus (RSV) vaccine, which was FDA-approved on May 31, 2024, and will be published in CPT 2025.
The Centers for Medicare and Medicaid Services (CMS) has also updated its guidance for physicians and practices billing for flu vaccine services.
ICD-10-CM Code Updates:
The FY 2025 ICD-10-CM updates, released on October 1, 2024, include 252 new codes, 36 deletions, and 13 revisions. Notably, new codes have been added to capture adverse effects related to vaccines and biological substances, such as T50.Z95A for adverse effects from other vaccines.
Use of Vaccine Administration Codes:
Vaccination procedures consist of two components: the vaccine product and its administration. The administration code should always be reported alongside the vaccine product code. For all vaccines, regardless of age, ICD-10 code Z23 (encounter for immunization) should be reported. Insurance providers may have additional requirements for claims.
The administration codes to report are as follows:
For children (through age 18):
- 90460: Immunization administration with counseling by a healthcare professional; for the first or only component of each vaccine or toxoid.
- 90461: Immunization administration with counseling by a healthcare professional; for each additional component of a vaccine or toxoid.
For adults:
- 90471: Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) for one vaccine.
- 90472: Immunization administration for each additional vaccine (single or combination).
Each separate administration of a single-component vaccine or the first component of a combination vaccine should be reported using 90460.
Documentation Requirements:
Healthcare providers must document the following information in the patient’s permanent medical record:
- Date of vaccine administration
- Vaccine manufacturer
- Lot number
- Route and site of administration
- Patient demographics
Providers should ensure that the coding and documentation comply with all relevant state and federal regulations.