| Table of Content |
|---|
| 1. Introduction 2. Why Vaccine Billing & Coding Matters in 2025 3. Benefits of Accurate Vaccine Billing & Coding 4. Key Vaccine Billing & Coding Updates for 2025 A. Deleted Codes B. Revised Codes C. New Codes D. Resequenced Codes 5. Common Vaccine Billing Denials & Solutions 6. Real-World Coding Examples 7. Importance of Documentation in Vaccine Billing |
Introduction
The year 2025 has brought major updates in vaccine billing and coding, impacting healthcare providers, medical billing companies, and revenue cycle managers.
These changes include deleted CPT codes, revised codes, newly introduced codes, and resequenced codes covering SARS-CoV-2, influenza, pneumococcal, meningococcal, and chikungunya vaccines.
At MedAlign Solutions, we provide a comprehensive guide to help healthcare organizations understand, implement, and benefit from the 2025 vaccine coding updates to maximize reimbursement and stay compliant.
Why Vaccine Billing & Coding Matters in 2025
Vaccine billing and coding 2025 isn’t just about compliance; it’s a financial lifeline for medical practices.
Incorrect or outdated CPT codes can result in claim denials, underpayments, or regulatory penalties.
By understanding CPT code updates for vaccines in 2025, you can ensure:
- Smooth claim submissions
- Faster reimbursements
- Compliance with AMA & CMS guidelines
- Better patient care outcomes
Benefits of Accurate Vaccine Billing & Coding
Accurate vaccine coding doesn’t just save time, it increases your revenue and reduces audit risks.
| Benefit | Why It’s Important |
|---|---|
| Prevent Revenue Loss | Avoid denied claims by using correct CPT codes. |
| Stay Compliant | Meet AMA guidelines and avoid costly penalties. |
| Improve Patient Care | Proper coding ensures faster vaccine administration and better patient experiences. |
| Maximize Reimbursement | Reflect updated vaccine formulations and doses for higher claim approvals. |
Key Vaccine Billing & Coding Updates for 2025
A. Deleted Codes
The following CPT codes are no longer recognized for reimbursement:
- 90630: Influenza vaccine, quadrivalent, live
- 90654: Influenza vaccine, trivalent, split virus
- 93890: No longer applicable
- 96003: Discontinued medical service
- 96040: Genetic counseling, replaced with new codes
Deleted SARS-CoV-2 Vaccine Codes:
91300–91317 (replaced with updated codes)
Deleted SARS-CoV-2 Administration Codes:
0001A–0004A, 0051A–0054A, 0071A–0074A, 0081A–0083A, 0121A–0124A, 0134A, 0141A–0144A, 0151A–0154A, 0164A, 0171A–0174A, 0011A–0013A, 0021A–0022A, 0031A–0034A, 0041A–0042A, 0044A, 0064A, 0091A–0094A, 0104A, 0111A, 0113A.
B. Revised Codes
Updated formulations, dosages, and administration guidelines:
- 91304: SARS-CoV-2 recombinant spike protein nanoparticle vaccine, saponin-based adjuvant, 5 mcg/0.5 mL
- 90661: Influenza vaccine, trivalent, derived from cell cultures
C. New Codes
New CPT codes introduced in 2025:
- 90593: Chikungunya virus vaccine, recombinant, intramuscular injection (for prevention of mosquito-borne fever)
D. Resequenced Codes
Updated sequencing ensures better claim accuracy:
- 90480: COVID-19 vaccine administration, single dose
- 91318 – 91322: New SARS-CoV-2 vaccine code range
- 90695: Influenza H5N8 vaccine, adjuvanted
- 90684: Pneumococcal conjugate vaccine, 21-valent (PCV21)
- 90637: Influenza quadrivalent mRNA vaccine, 30 mcg/0.5 mL
- 90638: Influenza quadrivalent mRNA vaccine, 60 mcg/0.5 mL
- 90624: Meningococcal pentavalent vaccine
Common Vaccine Billing Denials & Solutions
Vaccine billing denials lead to revenue leakage and compliance risks. Here’s how to fix them:
| Denial Reason | Cause | Solution |
|---|---|---|
| Code Mismatch | Using outdated CPT codes | Enable real-time CPT code updates in EHR systems |
| Invalid Dosage | Incorrect vaccine dose entered | Automate dose verification before claim submission |
| Missing NDC | National Drug Code not provided | Use automated NDC checks |
| Duplicate Billing | Same vaccine billed twice | Implement claim scrubbing systems |
| Payer-Specific Rules | Coverage limitations by insurance | MedAlign manages payer compliance seamlessly |
| Late Filing | Claims submitted after deadlines | Automate billing workflows for timely submissions |
Real-World Coding Examples
Example 1: Annual Flu Shot with Office Visit
Scenario:
A patient visits for an annual flu shot and has mild cold symptoms.
Coding:
- CPT Code: 90686 (quadrivalent flu vaccine)
- Administration Code: 90471 (first vaccine)
- Modifier 25: Added with E/M code for separate evaluation.
Example 2: Multiple Vaccines in One Appointment
Scenario:
A child receives both a pneumococcal and meningococcal vaccine.
Coding:
- CPT Codes: 90732 (pneumococcal) + 90734 (meningococcal)
- Administration Codes: 90471 (first vaccine) + 90472 (second vaccine)
Importance of Documentation in Vaccine Billing
Accurate documentation is the foundation of successful vaccine billing. Missing details cause claim denials and delayed payments.
Best Practices:
- Record vaccine type, manufacturer, lot number, and administration details.
- Document patient medical necessity.
- Ensure all information aligns with payer-specific requirements.
Why Choose MedAlign Solutions for Vaccine Billing?
At MedAlign Solutions, we simplify vaccine billing by:
- Managing CPT & ICD-10 updates
- Handling resequenced codes seamlessly
- Ensuring maximum reimbursement
- Avoiding denials and delays
- Providing expert reporting & audits
Conclusion
The 2025 vaccine billing & coding guidelines bring new CPT codes, resequenced codes, and payer-specific requirements. By understanding these updates and applying accurate billing practices, your practice can reduce denials, increase reimbursements, and stay audit-ready. Partner with MedAlign Solutions for expert vaccine billing support.
Let MedAlign Solutions Be Your Guide.
Contact us today for a free revenue cycle assessment. Our experts will help you analyze your denial trends, implement best practices, and unlock your full revenue potential. Stop leaving money on the table protecting one. This strategic approach is what truly separates high-performing practices from those struggling with revenue recovery.
Visit us at MedAlign Solutions LLC
Email us: Info@medalignsolutions.com
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