NDCs† (Syringe in package of 10)
To promote accuracy, always consult the most current Prescribing Information or product packaging when documenting NDCs.
If reporting multiple vaccine administrations given to a patient through age 18 on the same date along with counseling by a qualified healthcare professional, report one administration code (90460) for each vaccine administered
If a vaccine has multiple components, then 90460 should be reported once in conjunction with 90461 for each additional vaccine/ toxoid component contained within that vaccined.6
- *ICD-10-CM code Z23, Encounter for Immunization, is reported for all vaccines given within an encounter; additional ICD-10-CM coding may be needed.2
- †Note that some payers require an 11-digit NDC, which involves adding a "0" immediately after the first hyphen in each GSK NDC.7 For example, when reporting NDC 58160-820-11 to TRICARE, it becomes NDC 58160-0820-11.
- ‡Adapted from the American Medical Association, CPT 2021 Professional Edition, Current Procedural Terminology (CPT), 2020.
- Prescribing Information for PEDIARIX.
- Centers for Medicare and Medicaid Services. 2021 ICD-10-CM official guidelines for coding and reporting. https://www.cms.gov/files/document/2021-coding-guidelines-updated-12162020.pdf. Accessed February 23, 2021.
- Centers for Disease Control and Prevention. Immunization information systems (IIS): HL7 standard code set, MVX – manufacturers of vaccines. https://www2a.cdc.gov/vaccines/IIS/IISStandards/vaccines.asp?rpt=mvx. Accessed February 23, 2021.
- Centers for Disease Control and Prevention. Immunization information systems (IIS): Current HL7 standard code set, CVX – vaccines administered. https://www2a.cdc.gov/vaccines/IIS/IISStandards/downloads/cvx_list.pdf. Accessed February 23, 2021.
- American Medical Association. CPT category I new vaccine codes (including incorporation of ACIP abbreviations listing) long descriptors. https://www.ama-assn.org/system/files/2021-01/vaccine-long-descriptors.pdf. Accessed February 23, 2021.
- American Academy of Pediatrics. Bright futures coding for pediatric preventive care 2020. https://www.aap.org/en-us/documents/coding_preventive_care.pdf. Accessed February 23, 2021.
- Humana Military. Office injectable guidelines, national drug code (NDC) pricing and filing tips. https://www.humanamilitary.com/provider/education-and-resources/claims/office-injectable. Accessed February 23, 2021.
Please note that this website is provided for informational purposes only and is not intended to serve as comprehensive training on medical billing and coding. Additional training on medical coding may be required. The information on this website is believed to be accurate as of the date of publication. Users should independently verify accuracy.
Healthcare providers are responsible for making the ultimate decision on when to use a specific product based on clinical recommendations and how to bill for products and related services rendered. Consult third-party insurers' guidelines for specific information regarding the billing and reporting of services rendered.