Certified Medical Assistant (CMA AAMA)Administrative: Billing, Coding and SchedulingMedium
A medical assistant is performing a charge entry for a patient who received an influenza vaccination during an office visit. The physician administered the vaccine. Which of the following CPT codes would be needed to accurately bill for this service?
- AOnly the CPT code for the vaccine product.
- BA single CPT code that combines the product and administration.
- COnly the CPT code for the administration of the vaccine.
- DBoth the CPT code for the vaccine product and the administration.
Show answer & explanationAnswer & explanation
Correct answer: D. Both the CPT code for the vaccine product and the administration.
To accurately bill for a vaccine, two separate CPT codes are typically required: one for the vaccine product itself (what was given) and another for the administration of that vaccine (the act of giving it).
Why the other options are wrong
- A. Billing only for the product would miss reimbursement for the service of administering it.
- B. Most vaccines are billed with separate codes for the product and the administration, not a single combined code.
- C. Billing only for administration would miss reimbursement for the cost of the vaccine itself.
Vaccine Coding
The practice of using two distinct CPT codes to bill for vaccination services: one for the vaccine product and one for its administration.
- Requires two CPT codes per vaccine.
- Product code covers the cost of the vaccine.
- Administration code covers the service of injecting the vaccine.
- HCPCS Level II codes may also be used for some vaccine products.
Memory trick: Vaccine Billing: 'V' for Vaccine, 'A' for Administration — you need both!