Guides Specialty billing

90460 vs 90471: which vaccine administration code to bill

By Marlow’s billing manager, 20+ years in medical billing, former billing manager at Mount Sinai South Nassau, Oceanside · Updated November 9, 2026 · 7 min read

The short answer

Bill 90460, plus 90461 for each extra component, when the patient is 18 or younger and a physician or other qualified professional counsels the family face to face about the vaccine. Otherwise bill 90471 to 90474, which count vaccines, not components.

Use 90460 and 90461 when two things are true: the patient is 18 or younger, and a physician or other qualified health care professional counsels the patient or family face to face about the vaccine at the visit. If either is missing, use 90471 and 90472 (injections) or 90473 and 90474 (nasal or oral). The difference is how they count: the pediatric codes pay for each component of each vaccine, while the others pay per vaccine. That is why combination vaccines are where most of the money is won or lost.

This guide covers billing mechanics only. Which vaccines a child should get is a clinical question, and which ones are covered by the Vaccines for Children program follows CDC’s current resolutions.

The two code families side by side

CPT descriptors are copyrighted, so the table below paraphrases them. The rules come from CPT as summarized by the American Academy of Pediatrics (AAP, Coding for Pediatric Preventive Care 2025) and the American Academy of Family Physicians (AAFP, Coding for vaccine administration).

Code	What it covers (paraphrased)	Who and when
90460	First or only component of each vaccine, with counseling	Age 18 or younger, physician or QHP counsels face to face, any route
90461	Each additional component of the same vaccine (add-on)	Same conditions, only with 90460
90471	First vaccine given by injection	Any age, no counseling requirement
90472	Each additional vaccine by injection (add-on)	Any age
90473	First vaccine given by nose or mouth	Any age
90474	Each additional vaccine by nose or mouth (add-on)	Any age

A few rules that trip practices up:

Route doesn’t matter for 90460 and 90461. They cover shots, nasal sprays and oral vaccines alike.
90460 can be billed more than once at a visit, once for each vaccine given with counseling. 90471 and 90473 are “first vaccine” codes, so a visit has only one of them; extra vaccines go on 90472 or 90474 (AAP).
The vaccine product is billed separately. The administration codes pay for giving the vaccine, not for the vaccine itself.
Clinical staff can give the shot. The counseling has to come from the physician or other qualified health care professional, but a nurse or medical assistant can do the injection (AAP).

What counts as a component

CPT counts a component as all the antigens in a vaccine that protect against disease from one organism. Several strains or serotypes of the same organism count as one component. Conjugates and adjuvants don’t count (AAP).

So a vaccine against measles, mumps and rubella has three components: 90460 once and 90461 twice. A pneumococcal vaccine with many serotypes is still one organism: 90460 once, no 90461. A flu vaccine is one component.

When the counseling is missing

If the child is 18 or younger but nobody with billing privileges counseled the family about a particular vaccine, that vaccine goes on 90471 to 90474 instead. AAP’s guidance allows a split at one visit: 90460 and 90461 for the vaccines the provider counseled on, and 90472 or 90474 for the ones they didn’t (AAP).

The note has to show the counseling happened and who did it. A standing order and a signed consent form on their own don’t show that a physician or other qualified professional talked with the family about that vaccine.

Why it matters: an example

Example (for illustration only). A 4-year-old gets an MMR vaccine and a flu vaccine at a checkup, and the pediatrician counsels the parent on both.

Billed as	Codes	Medicare 2027 amount, Long Island
With counseling	90460 ×2, 90461 ×2	about $72.34
Without counseling	90471, 90472	about $43.42

The amounts are calculated from CMS’s CY2027 final-rule relative value units, the Long Island geographic indices (locality 02) and the $32.63 conversion factor, office setting (CMS CY2027 PFS final rule addenda; CMS fact sheet). Medicare rarely pays for a 4-year-old, and commercial and Medicaid plans set their own rates. The point is the gap: per unit, 90460 is about $26.64 and each 90461 about $9.53 at those rates, so components add up. Check your own fee schedules for the real numbers.

New York Medicaid and VFC vaccines

Children 18 and younger who are Medicaid eligible or enrolled, uninsured, American Indian or Alaska Native, or underinsured (at certain clinics) qualify for vaccine from the federal Vaccines for Children program. Children in a separate CHIP program count as insured and don’t qualify (CDC, VFC eligibility, as of November 2026).

For NY Medicaid fee-for-service, the eMedNY physician manual (April 2026) sets these rules for VFC-supplied vaccine (eMedNY Physician Procedure Codes, Medicine section; modifier rules):

Bill 90460 for the administration of VFC vaccine, including flu and pneumococcal.
Also bill the specific vaccine code with modifier SL (state supplied). That line pays $0.00. An administration code billed without an SL vaccine line is denied.
For payment, the components of a combination vaccine count as one administration. More than one 90460 can be paid on the same date. 90461 does not appear in eMedNY’s Medicine code list.
Leaving off the SL modifier on a vaccine for a patient under 19 causes a denial.
Payment for the VFC administration won’t exceed $17.85.
The provider must be enrolled with the VFC program to be paid for giving VFC vaccine to Medicaid patients under 19 (eMedNY Physician Manual Policy Guidelines).
For vaccines not supplied by VFC, bill the vaccine at acquisition cost.

Medicaid managed care plans and Child Health Plus pay vaccine administration under their own contracts, not the eMedNY fee schedule. NYS DOH says so directly in its VFC fee table (NYS DOH, VFC eligibility screening, revised October 2023). Check each plan’s policy before you assume it follows the state’s rules on 90461.

The VFC administration fee cap

VFC vaccine is free to the practice, but the administration fee isn’t free to bill. Federal rules cap what a provider may charge for giving VFC vaccine to an eligible child. For New York, CMS set the regional maximum at $25.10 per vaccine (Federal Register, Nov 6, 2012, 77 FR 66669, Table 1). We found no later federal update as of November 2026.

NYS DOH lists the same $25.10 as the maximum administration fee for VFC-eligible children who are uninsured, underinsured, American Indian or Alaska Native, or in Medicaid fee-for-service. It also says (NYS DOH):

VFC providers can’t charge the patient for publicly funded vaccine.
A child can’t be refused a publicly funded vaccine because the family can’t pay the administration fee. The provider must waive it.
Trying to force collection of administration fees from these families is prohibited.

For Medicaid fee-for-service, the two state sources don’t match: DOH’s table (October 2023) shows $25.10, while eMedNY’s procedure code manual (April 2026) says payment won’t exceed $17.85. Check what your remittances actually show.

In practice, your billing system needs to know which children are VFC eligible before the visit, so that self-pay statements for uninsured VFC children don’t go out above the cap or to collections.

A same-day visit and vaccines

A problem visit or preventive visit can be billed on the same day as vaccine administration. NY Medicaid’s rule: the office visit must be above the level of 99211, and it must carry modifier 25, with documentation that supports it (eMedNY Medicine section). For the general rule on 99211 with vaccine administration and on modifier 25, see modifier 25 in 2027. For a checkup and a sick visit on the same day, see well-child and sick visits on the same day.

Counseling without a shot

CPT also has codes for vaccine counseling by a physician or other qualified professional when no vaccine is given that day by the provider, split by time (90482 to 90484). Medicare lists them as not valid for Medicare payment for 2027 (CMS CY2027 Addendum B). eMedNY’s April 2026 Medicine list includes 90482. Commercial coverage varies, so check each plan before billing them.

New for Medicare in 2027: vaccine adverse effects

For 2027, CMS finalized an add-on code, G0576, for extra work in diagnosing and treating vaccine adverse effects beyond what an office visit captures: listening to concerns, answering questions and planning treatment of symptoms. Addendum B lists it as an add-on per 15 minutes (CMS fact sheet; CY2027 addenda). It is a Medicare code; whether commercial or Medicaid plans adopt it is up to them.

A checklist for vaccine administration claims

Confirm VFC eligibility before the visit, and record it.
For each vaccine, note who counseled and that it was face to face.
Count components per vaccine, not per visit.
Bill each vaccine product line, with SL for state-supplied stock.
For NY Medicaid fee-for-service VFC vaccine: 90460 per vaccine, no 90461.
For managed care and CHP: follow the plan’s own policy.
Keep self-pay administration charges for VFC children at or under $25.10, and waive them when the family can’t pay.

Sources

General information, not advice on a specific claim, contract or legal question. Rules and rates change; check the linked sources for the current version. CPT® is a registered trademark of the American Medical Association. Code descriptions here are paraphrased.