January Vax Corner
By Maria Huang, MD, FAAP, WCAAP Vaccine Committee Co-Chair
Happy New Year 2026!
Immunization counseling conversations are now compensated even when vaccines aren’t administered! As of Jan 1, 2026, three new time-based CPT codes take effect.
Documentation Requirements:
Specify vaccines counseled on, conversation details, reasons for declination, and underimmunization status. Include total time, clarifying it applies only to standalone vaccine counseling.
Coding and Billing:
- CPT codes 90482-90484 can be reported on the same date as E/M services (preventive care or illness visits)
- Modifier 25 should be added to the E/M code to indicate it is separately identifiable from immunization counseling
- Codes may be reported as the only service if the patient was scheduled for immunization-only visit and the provider addressed questions or concerns
ICD-10-CM Coding:
- The primary ICD-10-CM code for standalone immunization counseling is Z71.85 – Encounter for immunization safety counseling.
- It must be followed by a code from range Z28, Immunization not carried out, and underimmunization status.
- For example, Z28.21 (Immunization not carried out because of patient refusal) or Z28.310 (Unvaccinated for COVID-19) are complete codes, while Z28 or Z28.2 alone are incomplete.
- Code Z28.310 (Unvaccinated for COVID-19) can be reported when a patient is eligible for COVID-19 vaccination but the vaccine is not administered.
- This coding may help track COVID-19 vaccination status and spread.
