Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
www.mass.gov/masshealth
	
MassHealth
Physician Bulletin 90
April 2011


TO:	Physicians Participating in MassHealth

FROM:	Terence G. Dougherty, Medicaid Director

RE:	2011 Pediatric Immunization Administration Codes


Background

Effective January 1, 2011, two new pediatric immunization administration CPT 
codes have replaced Service Codes 90465-90468. These codes 
are:

90460 - Immunization administration through 18 years of age via any 
route of administration, with counseling by physician or other 
qualified health care professional; first vaccine/toxoid component
	
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/toxoid 
component
	
In these descriptors, a component refers to each antigen in a vaccine that 
prevents disease caused by one organism. Combination vaccines are 
those vaccines that contain multiple vaccine components (i.e., MMR, 
DTaP, and DTaP/IPV).
	

Reimbursement

In accordance with guidelines from the Centers for Medicare & Medicaid 
Services (CMS), under the Vaccine for Children (VFC) program, 
MassHealth will reimburse for vaccine administration on a per 
vaccine basis, and not on a per antigen or per combination basis.
	

Billing Guidelines

Providers should use the new Service Code 90460 for vaccines and to 
use the same service code with modifier SL for state-supplied vaccines 
(90460-SL). When multiple vaccines are provided, providers should 
indicate the number of vaccines (units) administered. Please Note: A 
vaccine with multiple antigens or components should always be billed 
with one unit. Additionally, if Service Code 90461 is used for a vaccine 
with multiple antigens or components, it will be paid at $0 value. 
	
(continued on next page)

MassHealth
Physician Bulletin 90
April 2011
Page 2


Billing Guidelines
(cont.)

Providers are reminded that in accordance with 130 CMR 433.413(C), a 
provider may bill only for the injectable material and its administration
when the immunization or injection is the primary purpose of an office or 
other outpatient visit. However, when the immunization or injection is not 
the primary purpose of the office or other outpatient visit, a provider may 
bill for both the visit and the injectable material, but not for its 
administration. MassHealth does not pay for the cost of the injectable 
material if (1) the Massachusetts Department of Public Health or a local 
board of health distributes the injectable material free of charge; or (2) its 
cost to the provider is $1.00 or less. See 130 CMR 433.413(C) and CMR 
433.443(C)(2)(a).
	
Questions

If you have any questions about the information in this bulletin, please 
contact MassHealth Customer Service at 1-800-841-2900, e-mail your 
inquiry to providersupport@mahealth.net, or fax your inquiry to 
617-988-8974.