CODING FOR

Pediatric
Preventive
Care
2022

TM
 Coding for Pediatric Preventive Care, 2022
This resource contains comprehensive listings of codes that may not
be used by your practice on a regular basis. We recommend that you
identify the codes most relevant to your practice and include those on
your encounter form or billing sheet.
Following are the Current Procedural Terminology (CPT®), Healthcare
Common Procedure Coding System (HCPCS) Level II, and International
Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)
codes most commonly reported by pediatricians in providing preventive
care services. The pediatrician, not the staff, is ultimately responsible for
the appropriate codes to report.

SYMBOL DESCRIPTION

• A bullet at the beginning of a code means it is a new code for the current year.
+ A plus sign means the code is an add-on code.
~ A lightning bolt indicates that a vaccine product code was approved, but the
vaccine product is still pending FDA approval.

The recommendations in this publication do not indicate an exclusive course of treatment or

serve as a standard of medical care. Variations, taking into account individual circumstances,
may be appropriate.
© 2022 American Academy of Pediatrics
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or
otherwise—without prior written permission from the publisher.
Printed in the United States of America
Current Procedural Terminology (CPT®) 5-digit codes, nomenclature, and other data are copyright
2021 American Medical Association (AMA). All rights reserved. No fee schedules, basic units,
relative values, or related listings are included in CPT. The AMA assumes no liability for the
data contained herein.
The Bright Futures/American Academy of Pediatrics “Recommendations for Preventive Pediatric
Health Care,” also known as the “periodicity schedule,” is a schedule of screenings and assessments
recommended at each well-child visit from infancy through adolescence. The following services
and codes coincide with this schedule. For more details on the periodicity schedule, see
https://www.aap.org/en/practice-management/care-delivery-approaches/periodicity-schedule/.

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 PREVENTIVE MEDICINE SERVICE CODES
Services included under these codes include measurements (eg, length/
height, head circumference, weight, body mass index, blood pressure)
and age- and gender-appropriate examination and history (initial or
interval).
▶ Preventive medicine service codes are not time-based; therefore, time
spent during the visit is not relevant in selecting the appropriate
preventive medicine service code.
▶ If an illness or abnormality is discovered, or a preexisting problem
is addressed, in the process of performing the preventive medicine
service, and if the illness, abnormality, or problem is significant
enough to require additional work to perform the components
of a problem-oriented evaluation and management (E/M) service
(ie, using medical decision making or time spent), the appropriate
office or other outpatient service code (99202–99215) should be
reported in addition to the preventive medicine service code.
Append modifier 25 to the office or other outpatient service
code (eg, 99392 and 99213 25).
▶ An insignificant or trivial illness, abnormality, or problem encountered
in the process of performing the preventive medicine service should
not be separately reported.
▶ The comprehensive nature of the preventive medicine service
codes reflects an age- and gender-appropriate history and physical
examination and is not synonymous with the comprehensive
examination required for some other E/M codes (eg, 99204,
99205, 99215).
▶ Immunization products and administration and ancillary studies
involving laboratory, radiology, or other procedures, or screening
tests (eg, vision, developmental, hearing) identified with a specific
CPT code, are reported and paid for separately from the preventive
medicine service code.
▶ For more information on coding during the COVID-19 pandemic
(including telemedicine and telehealth), refer to the AAP's coding
site (www.aap.org/coding) and its page dedicated to this coding.

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Preventive Medicine Services: New Patients
▶ Initial comprehensive preventive medicine E/M of an individual
includes an age- and gender-appropriate history; physical examination;
counseling, anticipatory guidance, or risk factor reduction interven-
tions; and the ordering of laboratory or diagnostic procedures.
▶ A new patient is defined as one who has not received any professional
face-to-face services rendered by physicians and other qualified health
care professionals (QHPs) who may report E/M services and reported
by a specific CPT code(s) from a physician/other QHP, or another
physician/other QHP of the exact same specialty and subspecialty
who belongs to the same group practice, within the past 3 years.

CPT Codes ICD-10-CM Codes

99381 Infant (younger than 1 year) Z00.110 Health supervision for newborn
under 8 days old or
Z00.111 Health supervision for newborn
8 to 28 days old or
Z00.121 Routine child health exam
with abnormal findings or
Z00.129 Routine child health exam
without abnormal findings
99382 Early childhood (age 1–4 years) Z00.121
99383 Late childhood (age 5–11 years) Z00.129
99384 Adolescent (age 12–17 years)
99385 18 years or older Z00.00 General adult medical exam
without abnormal findings
Z00.01 General adult medical exam
with abnormal findings

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Preventive Medicine Services: Established Patients
Periodic comprehensive preventive medicine reevaluation and manage-
ment of an individual includes an age- and gender-appropriate history;
physical examination; counseling, anticipatory guidance, or risk factor
reduction interventions; and the ordering of laboratory or diagnostic
procedures.

CPT Codes ICD-10-CM Codes

99391 Infant (younger than 1 year) Z00.110 Health supervision for newborn
under 8 days old or
Z00.111 Health supervision for newborn
8 to 28 days old or
Z00.121 Routine child health exam
with abnormal findings or
Z00.129 Routine child health exam
without abnormal findings
99392 Early childhood (age 1–4 years) Z00.121
99393 Late childhood (age 5–11 years) Z00.129
99394 Adolescent (age 12–17 years)
99395 18 years or older Z00.00 General adult medical exam
without abnormal findings
Z00.01 General adult medical exam
with abnormal findings

Preventive Medicine Services: With And Without Abnormal Findings

The use of an ICD-10-CM code for with abnormal findings (eg, Z00.121)
does not mean that an additional E/M service must or can be used.
Abnormal findings can be trivial or incidental issues that do not require
additional work, but the condition is still documented or listed as con-
tributory. Examples of abnormal findings include abnormal screening
results, new acute problem, or unstable or worsening chronic condition.
A stable chronic condition (whether addressed or not) would not warrant
the use of an abnormal findings code. You can link an abnormal findings
ICD-10-CM code to a screening if the screen is normal; the abnormality
will be identified with the appropriate ICD-10-CM code so the payer will
be aware.

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 COUNSELING, RISK FACTOR REDUCTION, AND
BEHAVIOR CHANGE INTERVENTION CODES
▶ Used to report services provided for the purpose of promoting health
and preventing illness or injury.
▶ They are distinct from other E/M services that may be reported
separately when performed. However, one exception is you cannot
report counseling codes (99401–99404) in addition to preventive
medicine service codes (99381–99385 and 99391–99395).
▶ Counseling will vary with age and address such issues as family
dynamics, diet and exercise, sexual practices, injury prevention,
dental health, and diagnostic or laboratory test results available
at the time of the encounter.
▶ Codes are time-based, where the appropriate code is selected
according to the approximate time spent providing the service.
Codes may be reported when the midpoint for that time has
passed. For example, once 8 minutes are documented, one may
report 99401.
▶ Extent of counseling or risk factor reduction intervention must
be documented in the patient chart to qualify the service based
on time.
▶ Counseling or interventions are used for persons without a specific
illness for which the counseling might otherwise be used as part of
treatment.
▶ Cannot be reported with patients who have symptoms or established
illness.
▶ For counseling individual patients with symptoms or established
illness, report an office or other outpatient service code (99202–
99215) instead.
▶ For counseling groups of patients with symptoms or established
illness, report 99078 (physician educational services rendered to
patients in a group setting) instead.

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Preventive Medicine, Counseling
CPT Codes
99401 Preventive medicine counseling or risk factor reduction
intervention(s) provided to an individual; approximately
15 minutes
99402 approximately 30 minutes
99403 approximately 45 minutes
99404 approximately 60 minutes
99411 Preventive medicine counseling or risk factor reduction
intervention(s) provided to individuals in a group setting;
approximately 30 minutes
99412 approximately 60 minutes

ICD-10-CM Codes for Preventive Counseling

▶ The diagnosis codes reported for preventive counseling will vary
depending on the reason for the encounter.
▶ Remember that the patient cannot have symptoms or established
illness; therefore, the diagnosis codes reported cannot reflect
symptoms or illnesses.
▶ Examples of some possible diagnosis codes include
Z28.3 Underimmunized status (Code also reason patient is behind,
eg, Z28.82 [caregiver refusal])
Z71.3 Dietary surveillance and counseling
Z71.82 Exercise counseling
Z71.84 Encounter for health counseling related to travel
Z71.85 Encounter for immunization safety counseling (Code also if
vaccine is not carried out [eg, Z28.82])
Z71.89 Other specified counseling
Z71.9 Counseling, unspecified

Behavior Change Interventions, Individual

▶ Used only when counseling a patient (not parent) on smoking
cessation (99406, 99407).
▶ If counseling a patient’s parent or guardian on smoking cessation, do
not report these codes (99406, 99407) under the patient; instead, refer

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 to preventive medicine counseling codes (99401–99404) if the patient
is not currently experiencing adverse effects (eg, illness), or include
under the problem-related E/M service if patient is present for a
sick visit (99202–99215).
▶ Codes 99406–99409 may be reported in addition to the preventive
medicine service codes.

CPT Codes
99406 Smoking and tobacco use cessation counseling visit;
intermediate, greater than 3 minutes up to 10 minutes
99407 intensive, greater than 10 minutes
99408 Alcohol or substance (other than tobacco) abuse structured
screening (eg, Alcohol Use Disorder Identification Test
[AUDIT], Drug Abuse Screening Test [DAST]) and brief
intervention (SBI) services; 15 to 30 minutes
99409 greater than 30 minutes

ICD-10-CM Codes for Risk Factor Reduction and Behavior Change

Interventions
F10.10 Alcohol abuse, uncomplicated
F11.10 Opioid abuse, uncomplicated
F12.10 Cannabis abuse, uncomplicated
F13.10 Sedative, hypnotic or anxiolytic abuse, uncomplicated
F13.90 Sedative, hypnotic, or anxiolytic use, unspecified, uncomplicated
F15.90 Other stimulant use, unspecified, uncomplicated
F16.90 Hallucinogen use, unspecified, uncomplicated
F17.290 Nicotine dependence, other tobacco products (Includes
Electronic nicotine delivery systems [ENDS]/vaping products)
Z71.41 Alcohol abuse counseling and surveillance of alcoholic
Z71.51 Drug abuse counseling and surveillance of drug abuser
Z71.6 Tobacco abuse counseling
Z87.891 Personal history of nicotine dependence
Z91.89 Other specified personal risk factors, presenting as hazards to
health not elsewhere classified

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 OTHER PREVENTIVE MEDICINE SERVICES
Oral Health
CPT Code
99188 Application of topical fluoride varnish by a physician or other
qualified health care professional
Refer to page 15 for the definition of QHP.

ICD-10-CM Codes
Z00.121 Routine child health exam with abnormal findings
Z00.129 Routine child health exam without abnormal findings
Z29.3 Encounter for prophylactic fluoride administration
Z91.841 Risk for dental caries, low
Z91.842 Risk for dental caries, moderate
Z91.843 Risk for dental caries, high
Z91.849 Unspecified risk for dental caries

Pelvic Examination
▶ Preventive medicine service codes (99381–99385 and 99391–99395)
include a pelvic examination as part of the age- and gender-appropriate
examination.
▶ If the patient is having a problem, the physician can report an office
or other outpatient E/M service code (99212–99215) for the visit and
attach modifier 25, which identifies that the problem-oriented pelvic
visit is a separately identifiable E/M service by the same physician on
the same date of service.
▶ Link the appropriate ICD-10-CM code for the well-child or well-adult
examination with abnormal findings (Z00.121 or Z00.01) to the
preventive medicine service code, but link a different diagnosis code
(eg, N89.8 [vaginal discharge], N94.4 [primary dysmenorrhea]) to
the office or other outpatient E/M service code (eg, 99212).
▶ Anticipatory or periodic contraceptive management is not a “problem”
and is therefore included in the preventive medicine service code;
however, if contraception creates a problem (eg, breakthrough
bleeding, vomiting), the service can be reported separately with
an office or other outpatient service code.

8
ICD-10-CM Codes
Z01.411 Gynecological exam with abnormal findings
Z01.419 Gynecological exam without abnormal findings
Z11.51 Screening for human papillomavirus (HPV)
Z12.72 Screening for malignant neoplasm of vagina
Z30.011 Initial prescription of contraceptive pills
Z30.012 Prescription of emergency contraception
Z30.013 Initial prescription of injectable contraceptive
Z30.014 Initial prescription of intrauterine contraceptive device (IUD)
Z30.015 Encounter for initial prescription of vaginal ring hormonal
contraceptive
Z30.016 Encounter for initial prescription of transdermal patch
hormonal contraceptive device
Z30.017 Encounter for initial prescription of implantable subdermal
contraceptive
Z30.018 Encounter for initial prescription of other contraceptives
Z30.02 Counseling and instruction in natural family planning to
avoid pregnancy
Z30.09 General counseling and advice on contraception
Z30.40 Surveillance of contraceptives, unspecified
Z30.41 Surveillance of contraceptive pills
Z30.42 Surveillance of injectable contraceptive
Z30.430 Insertion of IUD
Z30.431 Routine checking of IUD
Z30.432 Removal of IUD
Z30.433 Removal and reinsertion of IUD
Z30.44 Encounter for surveillance of vaginal ring hormonal
contraceptive device
Z30.45 Encounter for surveillance of transdermal patch hormonal
contraceptive device
Z30.46 Encounter for surveillance of implantable subdermal
contraceptive
Z30.49 Surveillance of other contraceptives
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Health Risk Assessments
CPT Codes
96160 Administration of patient-focused health risk assessment
instrument (eg, health hazard appraisal) with scoring and
documentation, per standardized instrument
96161 Administration of caregiver-focused health risk assessment in-
strument (eg, depression inventory) for the benefit of the patient,
with scoring and documentation, per standardized instrument
NOTE: Code 96161 can be reported for a postpartum screening administered
to a mother as part of a routine newborn check but billed under the baby’s
name. Link to ICD-10-CM code Z00.121 or Z00.129 for normal screening
results during a routine well-baby examination. Do not report ICD-10-CM
code Z13.31 or Z13.32 under the baby, as those are only for the maternal
record. Alternatively, payers may require G0442 (Annual alcohol misuse
screening, 15 minutes) in lieu of 96160 if screening for alcohol use.

▶ Used to report administration of standardized health risk assessment instru-

ments on the patient (96160) or a primary caregiver (eg, parent) on behalf of
the patient (96161). Code 96160 would be used to report a standardized
suicide risk assessment linked to ICD-10-CM code Z13.39 (Encounter for
screening examination for other mental health and behavioral disorders).
Code 96161 requires that the questions and answers relate to the primary
caregiver’s health and behaviors, not the patient’s. For standardized ques-
tionnaires about the family's environment (that includes the patient), report
code 96160.
▶ CPT defines standardization as, “Standardized instruments are validated tests
that are administered and scored in a consistent or ‘standard’ manner
consistent with their validation.”
▶ A non-standardized screen or assessment is not separately reported, unless a
specific payer allows.
▶ At the time of publication, the recommended Sudden Cardiac Arrest/Death
risk assessment was not standardized, therefore no separate CPT code can be
reported.

Unlisted Preventive Medicine Service

CPT Code
99429 Unlisted preventive medicine service
Report code 99429 only when a more specific preventive medicine service
code does not exist.

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 SCREENING CODES
Developmental/Autism Screening and Behavioral/Social/
Emotional Screening
CPT Codes ICD-10-CM Codes
96110 Developmental screening, Z13.41 Encounter for autism screening
per instrument, scoring Z13.42 Encounter for screening for global
and documentation developmental delays (milestones)
96127 Brief emotional/behavioral Z13.31 Encounter for screening for
assessment (eg, depression depression
inventory) with scoring Z13.39 Encounter for screening examination
and documentation, per for other mental health and
standardized instrument behavioral disorders

▶ Used to report administration of standardized developmental/autism

screening instruments (96110) or behavioral/social/emotional screening
instruments (96127). See page 10 for the definition of standardized.
▶ Often reported when performed in the context of preventive medicine
services but may also be reported when screening or assessment is
performed with other E/M services (eg, acute illness or follow-upoffice
visits).
▶ Clinical staff (eg, registered nurse) typically administers and scores the
completed instrument, while the physician incorporates the
interpretation component into the accompanying E/M service.
▶ When a standardized screening or assessment is administered along with
any E/M service (eg, preventive medicine service), both services should
be reported, and modifier 25 (significant, separately identifiable E/M
service by the same physician on the same day of the procedure or other
service) may need to be appended to the E/M code to show the E/M
service was distinct and necessary at the same visit.
▶ Alternatively, some payers may require the use of code G0444 (annual
depression screening, 15 minutes) in lieu of code 96127 for the routine
depression screening.
▶ For more information on reporting 96110 and 96127 instruments, refer to
https://downloads.aap.org/AAP/PDF/coding_factsheet_
developmentalscreeningtestingandEmotionalBehvioraassessment.pdf.

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Hearing Screening
CPT Codes ICD-10-CM Codes
92551 Screening test, pure tone, Z00.121 Routine child health exam
air only with abnormal findings
92552 Pure tone audiometry Z00.129 Routine child health exam
(threshold), air only without abnormal findings
92567 Tympanometry
(impedance testing)

▶ Requires use of calibrated electronic equipment; tests using other

methods (eg, whispered voice, tuning fork) are not reported separately.
▶ Includes testing of both ears; append modifier 52 when a test is applied
to only one ear.
▶ For newborn hearing screenings for young patients, including those
patients who are nonverbal or have developmental delays, other hearing
assessment methods may be more appropriate.

CPT Codes ICD-10-CM Codes

92558 Evoked otoacoustic emissions, Z00.110 Health supervision for
screening (qualitative measurement newborn under 8 days old
of distortion product or transient or
evoked otoacoustic emissions),
Z00.111 Health supervision for
automated analysis
newborn 8 to 28 days old
92650 Auditory evoked potentials; or
screening of auditory potential with Z00.121 Routine child health exam
broadband stimuli, automated with abnormal findings
analysis
Z00.129 Routine child health exam
without abnormal findings
P09.6 Abnormal findings on
neonatal screening

92587 Distortion product evoked

otoacoustic emissions; limited
evaluation (to confirm the presence
or absence of hearing disorder, 3-6
frequencies) or transient evoked
otoacoustic emissions, with
interpretation and report
92588 comprehensive diagnostic
evaluation, with interpretation
and report

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▶ Codes Z01.10 (encounter for examination of ears and hearing without
abnormal findings) and Z01.118 (encounter for examination of earsand
hearing with other abnormal findings) are reported only when a patient
presents for an encounter specific to ears and hearing, not for a routine
well-child examination at which a hearing screening is performed.
▶ Failed hearing screenings will most likely result in a follow-up office
visit (eg, 99212–99215). Code Z01.110 (encounter for hearing exami-
nation following failed hearing screening) is reported when a specific
disorder cannot be identified or when the follow-up hearing screening
findings are normal. You can also report Z01.118 (encounter for exam-
ination of ears and hearing with other abnormal findings) and include
the code for the abnormal findings (eg, R94.120 [abnormal auditory
function study]).

Vision Screening
CPT Codes ICD-10-CM Codes
99173 Screening test of visual acuity Z01.020 Encounter for examination of eyes
quantitative, bilateral and vision following failed vision
screening without abnormal
findings
Z01.021 Encounter for examination of eyes
and vision following failed vision
screening with abnormal findings
Z00.121 Routine child health exam
with abnormal findings
99174 Instrument-based ocular Z00.129 Routine child health exam
screening (eg, photoscreening, without abnormal findings
automated-refraction), bilateral,
with remote-analysis and report
99177 Instrument-based ocular
screening (eg, photoscreening,
automated-refraction), bilateral,
with on-site analysis

Z01.00 and Z01.01 (examination of eyes and vision with and without
abnormal findings) are reported only for routine examination of eyes and
vision, not when a vision screening is done during a routine well-child
examination.

13
▶ To report code 99173, you must employ graduate visual acuity stimuli
that allow a quantitative estimate of visual acuity (eg, Snellen chart).
▶ Codes 99174 and 99177 are reported for instrument-based ocular
screening for esotropia, exotropia, anisometropia, cataracts, ptosis,
hyperopia, and myopia.
▶ Code 99177 is reported in lieu of 99174 when the screening instrument
provides you with immediate pass or fail results.
▶ When acuity (99173) or instrument-based ocular screening (eg, 99174)
is measured as part of a general ophthalmologic service or an E/M
service of the eye (eg, for an eye-related problem or symptom), it
is considered part of the diagnostic examination of the office or
other outpatient service code (99202–99215) and is not reported
separately.
▶ Other identifiable services unrelated to the screening test provided
at the same time are reported separately (eg, preventive medicine
services).
▶ Failed vision screenings will most likely result in a follow-up office
visit (eg, 99212–99215). Report the follow-up screening with
Z01.020 (encounter for examination of eyes and vision following
failed vision screening without abnormal findings) if normal results
or Z01.021 (encounter for examination of eyes and vision following
failed vision screening with abnormal findings) if abnormal results.
If abnormal, link to the diagnosis code for the reason for the failure
(eg, H52.1- [myopia]); when a specific disorder cannot be identified,
report R94.118 (abnormal results of other function studies of eye).

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 IMMUNIZATIONS
Immunization Administration (IA)
Pediatric IA Codes
90460 Immunization administration (IA) through 18 years of age
via any route of administration, with counseling by physician
or other qualified health care professional; first or only
component of each vaccine or toxoid administered
+90461 each additional vaccine or toxoid component
administered (List separately in addition to code for
primary procedure.)
Report 90461 in conjunction with 90460.
▶ Component refers to all antigens in a vaccine that prevent diseases
caused by 1 organism. Multivalent antigens or multiple serotypes of
antigens against a single organism are considered a single component
of vaccines. Combination vaccines are vaccines that contain multiple
vaccine components. Conjugates or adjuvants contained in vaccines
are not considered to be component parts of the vaccine, as defined
previously.
▶ A QHP is an individual who by education, training, licensure/
regulation, facility credentialing (when applicable), and payer policy
is able to perform a professional service within his or her scope of
practice and to independently report a professional service. These
professionals are distinct from clinical staff. A clinical staff member
is a person who works under the supervision of a physician or other
QHP and who is allowed by law, regulation, facility, and payer policy
to perform or assist in the performance of specified professional
services but does not individually report any professional services.
▶ Code 90460 is used to report the first or only component in a single
vaccine given during an encounter. You can report 90460 more than
once during a single office encounter. Code 90461 is considered an
add-on code to 90460 (hence the + symbol next to it). This means
that the provider will use 90461 in addition to 90460 if more than
1 component is contained within a single vaccine administered.
CPT codes 90460 and 90461 are reported regardless of route of
administration.

15
▶ Pediatric IA codes (90460, 90461) are reported only when both of the
following requirements are met:
1. The patient must be 18 years or younger.
2. The physician or other QHP must perform face-to-face vaccine
counseling associated with the administration.

NOTE: The clinical staff can do the actual administration of the vaccine.

▶ If both of these requirements are not met, report a non–age-specific

IA code (90471–90474) instead.

Non–age-specific IA Codes
▶ Report a CPT code for both the administration and product and an
ICD-10-CM code for each vaccine administered during a patient
encounter.
90471 IA (includes percutaneous, intradermal, subcutaneous, or
intramuscular injections); one vaccine (single or combination
vaccine/toxoid)
Do not report 90471 in conjunction with 90473.
+90472 each additional vaccine (single or combination vaccine/
toxoid) (List separately to code for primary procedure.)
Use 90472 in conjunction with 90460, 90471, or 90473.
90473 IA (includes intranasal or oral administration); one vaccine
(single or combination vaccine/toxoid)
Do not report 90473 in conjunction with 90471.
+90474 each additional vaccine (single or combination vaccine/
toxoid) (List separately to code for primary procedure.)
Use 90474 in conjunction with 90460, 90471, or 90473.
▶ Codes 90471 and 90473 are used to code for the first immunization
given during a single office visit. Codes 90472 and 90474 are con-
sidered add-on codes (hence the + symbol next to them) to 90460,
90471, and 90473. This means that the provider will use 90472 or
90474 in addition to 90460, 90471, or 90473 if more than 1 vaccine
is administered during a visit. There can be only 1 first administration
during a given visit. (See vignettes 3, 4, and 5 on pages 21–23.)

16
▶ If during a single encounter for a patient 18 years or younger, a physi-
cian or other QHP only counsels on some of the vaccines, report code
90460 (and 90461 when applicable) for those counseled on and defer
to codes 90472 or 90474, as appropriate, for those that are not
counseled on.
▶ The following vignettes may help illustrate the correct use of the
administration codes (see pages 25–28 for a full list of vaccine
product codes):

NOTE: The coding vignettes are for teaching purposes only and do not
necessarily follow every payer’s reporting requirements.

Vignette 1
A 2-month-old established patient presents for her checkup. The follow-
ing vaccines are ordered: Pentacel (diphtheria-tetanus-acellular pertussis
[DTaP], Haemophilus influenzae type b [Hib], inactivated poliovirus
[IPV]), pneumococcal, and rotavirus. The physician counsels the parents
on all of them, consent is obtained and the nurse administers them all.
How are the appropriate codes for this service selected?
Step 1: Select appropriate E/M code.
99391 Preventive medicine service, established patient, infant
(age younger than 1 year)
Step 2: Select appropriate vaccine product codes.
90698 DTaP-Hib-IPV (Pentacel) product
90670 Pneumococcal product
90680 Rotavirus vaccine, oral use
Step 3: Select appropriate IA codes by considering the following questions:
▶ Is the patient 18 years or younger?

▶ If the patient is younger than 18 years, did the physician or other QHP
perform the face-to-face vaccine counseling, discussing the specific
risks and benefits of the vaccines?
If the answer to both questions is yes, select a code from the pediatric IA
code family (90460, 90461). If the answer to one of the questions is no,
select a code from the non–age-specific IA code family (90471–90474).
In this vignette, the answer to both questions is yes. Therefore, IA codes
90460 and 90461 will be reported.

17
Step 4: Select the appropriate ICD-10-CM diagnosis codes.
Diagnosis codes are used along with CPT codes to reflect the outcome
of a visit. The CPT codes tell a carrier what was done, and ICD-10-CM
codes tell a carrier why it was done.
The vaccine product CPT code and its corresponding IA CPT code are
always linked to the same ICD-10-CM code. This is because the vaccine
product and work that goes into administering that product are intended
to provide prophylactic vaccination against a certain type of disease.
ICD-10-CM lists only a single code to describe an encounter in which
a patient receives a vaccine. The code is Z23, and it is reported at any
encounter when a vaccine is given, including routine well-child or
adult examinations.
The diagnosis codes for the 3 vaccines and 3 IA codes used in this vignette
are as follows:

CPT Codes ICD-10-CM Codes

99391 25 Preventive medicine service, established patient, Z00.129
<1 year
90698 DTaP-Hib-IPV (Pentacel) product Z23
90670 Pneumococcal product Z23
90680 Rotavirus vaccine, oral use Z23
90460 (×3) Pediatric IA (Pentacel, pneumococcal, rotavirus), Z23
first component
90461 (×4) Pediatric IA (Pentacel), each additional Z23
component

Vignette 2
A 5-year-old established patient is at a physician’s office for her annual
well-child examination. The patient is scheduled to receive her first
hepatitis A vaccine; her fifth DTaP vaccine; and the influenza vaccine.
After distributing the Vaccine Information Statements and discussing
the risks and benefits of immunizations with her parents, the physician
administers the vaccines.
How are the appropriate codes for this service selected?

18
Step 1: Select appropriate E/M code.
99393 Preventive medicine service, established patient, age 5 to
11 years
Step 2: Select appropriate vaccine product codes.
90633 Hepatitis A vaccine, pediatric/adolescent dosage
(2-dose schedule), for intramuscular use
90700 DTaP, for use in individuals younger than 7 years,
for intramuscular use
90686 Influenza virus vaccine, quadrivalent (IIV4), split virus,
preservative free, 0.5 mL dosage, for IM use
Step 3: Select appropriate IA codes by considering the following questions:
▶ Is the patient 18 years or younger?

▶ If the patient is younger than 18 years, did the physician or other

qualified health care professional perform the face-to-face vaccine
counseling, discussing the specific risks and benefits of the vaccines?
If the answer to both questions is yes, select a code from the pediatric IA
code family (90460, 90461). If the answer to one of the questions is no,
select a code from the non–age-specific IA code family (90471–90474).
In this vignette, the answer to both questions is yes. Therefore, IA codes
90460 and 90461 will be reported.
Step 4: Select the appropriate ICD-10-CM diagnosis codes.
Diagnosis codes are used along with CPT codes to reflect the outcome
of a visit. The CPT codes tell a carrier what was done, and ICD-10-CM
codes tell a carrier why it was done.
The vaccine product CPT code and its corresponding IA CPT code are
always linked to the same ICD-10-CM code. This is because the vaccine
product and work that goes into administering that product are intended
to provide prophylactic vaccination against a certain type of disease.
ICD-10-CM lists only a single code to describe an encounter in which
a patient receives a vaccine. The code is Z23, and it is reported at any
encounter when a vaccine is given, including routine well-child or
adult examinations.

19
The diagnosis codes for the 3 vaccines and 3 IA codes used in this
vignette are as follows:
CPT Codes ICD-10-CM Codes
99393 25 Preventive medicine service, established patient, Z00.129
5–11 years
90633 Hepatitis A vaccine product Z23
90460 Pediatric IA (hepatitis A vaccine), first component Z23
90700 DTaP vaccine product Z23
90460 Pediatric IA (DTaP vaccine), first component Z23
90461 (×2) Pediatric IA (DTaP vaccine), each additional Z23
component
90686 Influenza virus vaccine, quadrivalent, preservative Z23
free, 0.5 mL dosage
90460 Pediatric IA (influenza vaccine), first component Z23

Alternative Coding
CPT Codes ICD-10-CM Codes
99393 25 Preventive medicine service, established patient, Z00.129
5–11 years
90633 Hepatitis A vaccine product Z23
90700 DTaP vaccine product Z23
90686 Influenza virus vaccine, quadrivalent, preservative Z23
free, 0.5 mL dosage
90460 (×3) Pediatric IA (hepatitis A, DTaP, influenza vaccines), Z23
first component
90461 (×2) Pediatric IA (DTaP vaccine), second and third Z23
components

NOTE: Most payers do not want multiple line items of codes 90460 or
90461; therefore, follow the alternative coding.

20
Rationale
Because the patient is younger than 18 years and there is physician coun-
seling, pediatric IA codes are reported (90460 and 90461). Each vaccine
administered will be reported with its own 90460 (hepatitis A, DTaP,
and influenza). The only vaccine with multiple components is DTaP.
Because the first component (ie, diphtheria) was counted in 90460, only
the second and third components (ie, tetanus and acellular pertussis) are
reported with 90461 with 2 units.

Vignette 3
A 19-year-old patient presents to the office to complete a college physical
examination (in college the patient will be living in a dormitory). He is due
for a tetanus-diphtheria-acellular pertussis (Tdap) booster, meningococcal
vaccine, and intranasal influenza vaccine. The physician counsels the
patient on each, and the nurse administers each.
CPT Codes ICD-10-CM Codes
99395 25 Preventive medicine service, established patient, Z02.0
18–39 years
90715 Tdap product Z23
90471 IA, first injection Z23
90734 Meningococcal conjugate vaccine (MenACWY-D Z23
or MenACWY-CRM)
90472 IA, each additional injection Z23
90672 Influenza virus vaccine, quadrivalent, live (LAIV4), Z23
for intranasal use
90474 IA, each additional oral or intranasal Z23

Rationale
The patient is older than 18 years; therefore, despite physician counseling,
pediatric IA codes cannot be reported. Instead, codes 90471 and 90474
must be used.

21
Vignette 4
A 17-year-old patient presents to the office for her annual checkup and
to complete a college physical examination (in college the patient will be
living in a dormitory). The patient is healthy and due for a Tdap booster,
meningococcal vaccine, first HPV (9-valent) vaccine, and influenza
vaccine. The physician counsels the patient only on the meningococcal
and HPV vaccines, and the nurse administers each. The patient is asked
to return in 4 to 6 weeks for her second HPV vaccine.
CPT Codes ICD-10-CM Codes
(First Visit Only) (First Visit Only)
99395 25 Preventive medicine service, established patient, Z00.0 and Z02.0
12–17 years
90734 Meningococcal (MCV4) product Z23
90651 HPV (9-valent) product Z23
90460 (×2) Pediatric IA (meningococcal and HPV), first Z23
component
90715 Tdap product Z23
90472 (×2) IA, each additional injection (Tdap) Z23
90686 Influenza virus vaccine, quadrivalent, preservative Z23
free, 0.5 mL dosage

Rationale
Because the physician documents counseling only for the meningococcal
and HPV vaccines, code 90460 can be reported only for those vaccines
because the patient meets the age criteria. For the Tdap and influenza
vaccines, defer to non-pediatric IA codes (90471, 90472). In this case,
however, a first vaccine code is already reported with code 90460, so
the additional IA code 90472 has to be reported. While ICD-10-CM
does not provide official ages for the “adult” ICD-10-CM codes (Z00.00
and Z00.01) in lieu of the well-child examination codes, many payers
use age 17 years as the cutoff. Refer to specific payer policy for details.

Vignette 5
A 6-month-old patient presents to the office for her routine checkup and
to receive vaccines. The patient is due for DTaP, pneumococcal, and hepa-
titis B vaccines. During the examination, the physician finds an upper
respiratory infection and fever. The physician counsels the parent on the
vaccines but decides to defer for 2 weeks. The physician completes the
well-baby checkup on that day.
Two weeks later, the patient returns. The patient is afebrile and asymptom-
atic and is seen only by the nurse. The DTaP, pneumococcal, and hepatitis
B vaccines are administered.
22
 CPT Code ICD-10-CM Code
(First Visit) (First Visit)
99391 Preventive medicine service, established Z00.121
patient, <1 year
An appropriate acute sick visit (eg, 99213) may be reported in addition with modifier 25
and linked to an appropriate ICD-10-CM code.
CPT Codes ICD-10-CM Codes
(2 Weeks Later) (2 Weeks Later)
90700 DTaP product Z23
90670 Pneumococcal product Z23
90744 Hepatitis B vaccine product Z23
90471 IA (DTaP), first vaccine Z23
90472 (×2) IA (pneumococcal, hepatitis B), each Z23
additional vaccine

Rationale
If counseling occurs outside the IA service, there is no way to report it
separately. Therefore, in this vignette, there is nothing separate to report
during the well-baby visit, and when the patient returns and sees only the
nurse, pediatric IA codes cannot be reported; defer to codes 90471–90474.
During the preventive medicine service, when an acute illness is detected,
a code from 99212–99215 can be reported if the service is significant and
separately identifiable. Code 9921x is reported with modifier 25. When
the patient returns only for vaccines, an E/M service is not reported. The
ICD-10-CM code will be reported for with abnormal findings (Z00.121)
because an abnormality was identified during the encounter.
For more information on IA codes, refer to the AAP's coding website
(www.aap.org/coding) and its page dedicated to vaccine coding.

How to Code When Immunizations Are Not Administered

ICD-CM-10 Codes
▶ For many reasons, immunizations are not given during routine pre-
ventive medicine services. Parents may refuse vaccines or defer them,
a patient may be ill at the time and it is counteractive to administer,
or the patient may already have had the disease or be immune.
▶ Because of tracking purposes and quality measures, it is important
to report non-administration as part of the ICD-10-CM codes. The
following ICD-10-CM codes were created to report why a vaccine is
not given:

23
Vaccination not carried out due to
Z28.01 Acute illness
Z28.02 Chronic illness or condition
Z28.03 Immunocompromised state
Z28.04 Allergy to vaccine or component
Z28.1 Religious reasons
Z28.20 Unspecified reason
Z28.21 Patient refusal
Z28.81 Patient had disease being vaccinated against
Z28.82 Caregiver refusal
Z28.83 Vaccine was unavailable (eg, manufacturer delay)
Z28.89 Other reason

Vignette
A 1-year-old presents for his routine well-child examination. He is
scheduled to receive his first measles, mumps, rubella; hepatitis A; and
varicella vaccines. Because he had a documented case of varicella when
he was 9 months of age, the varicella vaccine is not given.
Report the following ICD-10-CM codes linked to the E/M service:
Z23 Encounter for immunization
Z28.81 Vaccination not carried out due to patient having had the
disease being vaccinated against

COVID-19 IA
As the public health emergency continues to evolve so does coding
for the COVID-19 vaccines. Refer to the online resource for more
information on reporting COVID-19 vaccines (https://www.aap.org/en/
pages/2019-novel-coronavirus-covid-19-infections/covid-19-vaccine-for-
children/covid-19-vaccine-administration-getting-paid/)

Tips:
▶ Do not charge for the product; however, you may report it if the payer
wants the product code included.
▶ Each specific vaccine and dose has its own unique administration code.
▶ If giving a COVID-19 vaccine in addition to routine vaccines,
a modifier might be required to override any payer edits.

24
 VACCINES FOR CHILDREN PROGRAM
The rules for reporting vaccines for patients who qualify for the Vaccines
for Children (VFC) program vary greatly. Some states require that the
product code be submitted, while others require the IA codes. Some
require the use of modifiers, while others do not. Currently, the VFC
program does not recognize component-based vaccine counseling; there-
fore, you will not be paid for CPT code 90461. The American Academy
of Pediatrics continues to work on changing this so pediatric providers
can be properly compensated for giving multiple-component vaccines.
Also be sure to check with your individual state Medicaid plan for vary-
ing rules, including, but not limted to, being able to report code 99211
in addition to IA codes for vaccine-only encounters. Be sure to get
these rules in writing.
Commonly Administered Pediatric Vaccines (Excludes COVID-19 vaccines -
refer to link on page 24)
Separately report the
administration with No. of
Product codes 90460–90461 Vaccine
Code or 90471–90474. Manufacturer Brand Components
90702 Diphtheria and tetanus SP Diphtheria 2
toxoids (DT), adsorbed when and Tetanus
administered to younger than Toxoids
seven years, for IM use Adsorbed
90700 Diphtheria, tetanus toxoids, SP DAPTACEL 3
and acellular pertussis vaccine GSK INFANRIX
(DTaP), when administered to
<7 years, for IM use
90696 Diphtheria, tetanus toxoids, GSK KINRIX 4
and acellular pertussis vaccine SP Quadracel
and inactivated poliovirus
vaccine (DTaP-IPV), when
administered to children
4-6 years of age, for IM use
90697 Diphtheria, tetanus toxoids, Merck/SP VAXELIS 6
acellular pertussis vaccine,
inactivated poliovirus vaccine,
w PRP-OMP conjugate
vaccine, and hepatitis B
vaccine (DTaP-IPV-Hib-HepB),
for IM use

25
Commonly Administered Pediatric Vaccines (continued)
Separately report the
administration with No. of
Product codes 90460–90461 Vaccine
Code or 90471–90474. Manufacturer Brand Components
90698 Diphtheria, tetanus toxoids, SP Pentacel 5
acellular pertussis vaccine,
Haemophilus influenzae type b,
and inactivated poliovirus
vaccine (DTaP-IPV/Hib),
for IM use
90723 Diphtheria, tetanus toxoids, GSK PEDIARIX 5
acellular pertussis vaccine,
Hepatitis B, and inactivated
poliovirus vaccine (DTaP-
Hep B- IPV), for IM use
90633 Hepatitis A vaccine (Hep A), GSK HAVRIX 1
pediatric/adolescent dosage, Merck VAQTA
2 dose, for IM use
90740 Hepatitis B vaccine (Hep B), Merck RECOMBIVAX 1
dialysis or immunosuppressed HB
patient dosage, 3 dose,
for IM use
90743 Hepatitis B vaccine (Hep B), Merck RECOMBIVAX 1
adolescent, 2 dose, for IM use HB
90744 Hepatitis B vaccine (Hep B), Merck RECOMBIVAX 1
pediatric/adolescent dosage, HB
3 dose, for IM use GSK ENERGIX-B
90746 Hepatitis B vaccine (Hep B), Merck RECOMBIVAX 1
adult dosage, for IM use HB
GSK ENERGIX-B
90747 Hepatitis B vaccine (Hep B), GSK ENERGIX-B 1
dialysis or immunosuppressed
patient dosage, 4 dose,
for IM use
90647 Haemophilus influenzae type b Merck PedvaxHIB 1
vaccine (Hib), PRP-OMP
conjugate, 3 dose, for IM use
90648 Haemophilus influenzae type b SP ActHIB 1
vaccine (Hib), PRP-T conjugate, GSK HIBERIX
4 dose, for IM use
90651 Human Papillomavirus vaccine Merck GARDASIL 9 1
types 6, 11, 16, 18, 31, 33, 45,
52, 58, nonavalent (HPV), 2 or
3 dose schedule, for IM use

26
 Separately report the
administration with No. of
Product codes 90460–90461 Vaccine
Code or 90471–90474. Manufacturer Brand Components
90707 Measles, mumps, and rubella Merck M-M-R II 3
virus vaccine (MMR), live, for
subcutaneous use
90710 Measles, mumps, rubella, and Merck ProQuad 4
varicella vaccine (MMRV), live,
for subcutaneous use
90619 Meningococcal conjugate SP MenQuadfi 1
vaccine, serogroups A, C, W, Y,
quadrivalent, tetanus toxoid
carrier (MenACWY-TT), for
IM use
90620 Meningococcal recombinant GSK Bexsero 1
protein and outer membrane
vesicle vaccine, serogroup B
(MenB-4C), 2 dose schedule,
for IM use
90621 Meningococcal recombinant Pfizer Trumenba 1
lipoprotein vaccine, serogroup B,
2 or 3 dose schedule, for IM use
90734 Meningococcal conjugate SP Menactra 1
vaccine, serogroups A, C, W, Y, GSK Menveo
quadrivalent, diphtheria toxoid
carrier (MenACWY-D) or CRM197
carrier(MenACWY-CRM), for
IM use
90670 Pneumococcal conjugate Pfizer PREVNAR 13 1
vaccine, 13 valent (PCV13),
for IM use
90732 Pneumococcal polysaccharide Merck PNEUMOVAX 1
vaccine, 23-valent (PPSV23), 23
adult or immunosuppressed
patient dosage, when adminis-
tered to 2 years or older, for
subcutaneous or IM use
90713 Poliovirus vaccine (IPV), SP IPOL 1
inactivated, for subcutaneous
or IM use
90680 Rotavirus vaccine, pentavalent Merck RotaTeq 1
(RV5), 3 dose schedule, live,
for oral use
90681 Rotavirus vaccine, human, GSK ROTARIX 1
attenuated (RV1), 2 dose
schedule, live, for oral use
27
Commonly Administered Pediatric Vaccines (continued)
Separately report the
administration with No. of
Product codes 90460–90461 Vaccine
Code or 90471–90474. Manufacturer Brand Components
90714 Tetanus and diphtheria toxoids MBL TDVAX 2
(Td) adsorbed, preservative SP TENIVAC
free, when administered to
seven years or older, for IM use
90715 Tetanus, diphtheria toxoids SP ADACEL 3
and acellular pertussis vaccine GSK BOOSTRIX
(Tdap), when administered to
7 years or older, for IM use
90716 Varicella virus vaccine (VAR), Merck VARIVAX 1
live, for subcutaneous use
90749 Unlisted vaccine or toxoid Please see CPT manual.
90672 Influenza virus vaccine, quad AstraZeneca Flumist Quad 1
(LAIV), live, intranasal use
90674 Influenza virus vaccine, quad Seqirus Flucelvax 1
(ccIIV4), derived from cell
cultures, subunit, preservative
and antibiotic free, 0.5 mL
dosage, IM
90682 Influenza virus vaccine, Seqirus Flublok Quad 1
quad (RIV4), derived from
recombinant DNA, HA protein
only, preservative and
antibiotic free, IM use
90685 Influenza virus vaccine, quad Seqirus Afluria 1
(IIV4), split virus, preservative GSK Fluarix
free, 0.25ml dose, for IM use SP Fluzone Quad
90686 Influenza virus vaccine, quad Seqirus Afluria 1
(IIV4), split virus, preservative GSK FLUARIX Quad
free, 0.5ml dosage, for IM use GSK FLULAVAL
SP Fluzone Quad
90687 Influenza virus vaccine, Seqirus Afluria Quad 1
quad (IIV4), split virus, SP Fluzone Quad
0.25ml dosage, for IM use
90688 Influenza virus vaccine, Seqirus Afluria 1
quad (IIV4), split virus, SP Fluzone Quad
0.5ml dosage, for IM use
90756 Influenza virus vaccine, quad Seqirus Flucelvax Quad 1
(ccIIV4), derived from cell
cultures, subunit, antibiotic
free, 0.5mL dosage, for IM use
Current at time of publication. Developed and maintained by the American Academy of Pediatrics. Updated
periodically at https://downloads.aap.org/AAP/PDF/coding_vaccine_coding_table.pdf. For reporting purposes
only. Any vaccine products still US Food and Drug Administration pending are not listed in this resource.

28
 LABORATORY
Two different practice models surround the conducting of laboratory
tests: blood is drawn in office and specimen is sent to an outside laboratory
for analysis, or blood is drawn and laboratory tests are performed in the
physician’s practice. Never report the laboratory code for a laboratory test
that the practice does not run in-house or is not financially responsible for
and billed by the outside laboratory. In those cases, report only the blood
draw and specimen handling, as appropriate.

Model 1: Blood is drawn in office and specimen is sent to an outside

laboratory for analysis.
CPT Code
99000 Handling and/or conveyance of specimen for transfer from
the physician’s office to a laboratory

Venipuncture CPT Codes

36406 Venipuncture, younger than 3 years, necessitating physician’s
skill, not to be used for routine venipuncture
36410 Venipuncture, 3 years or older, necessitating physician’s skill,
for diagnostic or therapeutic purposes (not to be used for
routine venipuncture)
36415 Collection of venous blood by venipuncture
36416 Collection of capillary blood specimen (eg, finger, heel, ear stick)

Venipuncture ICD-10-CM Codes

Link to ICD-10-CM codes for the well-child examination or for specific
screening tests.

Model 2: Blood is drawn and laboratory tests are performed in the

physician’s practice.
Venipuncture CPT Codes
36406 Venipuncture, younger than 3 years, necessitating physician’s
skill, not to be used for routine venipuncture
36410 Venipuncture, 3 years or older, necessitating physician’s skill,
for diagnostic or therapeutic purposes (not to be used for
routine venipuncture)
36415 Collection of venous blood by venipuncture
36416 Collection of capillary blood specimen (eg, finger, heel, ear stick)

29
Venipuncture ICD-10-CM Codes
Link to ICD-10-CM codes for the well-child examination or for specific
screening tests.

Anemia Screening CPT Code

85018 Blood count; hemoglobin

Anemia Screening ICD-10-CM Code

Z13.0 Encounter for screening for diseases of the blood and
blood-forming organs and certain disorders involving the
immune mechanism (eg, anemia)

Bilirubin CPT Codes

82247 Bilirubin, total
88720 Bilirubin, total, transcutaneous

Bilirubin ICD-10-CM Code

Z13.228 Encounter for screening for other metabolic disorder

Dyslipidemia Screening CPT Codes

80061 Lipid panel (includes total cholesterol, high-density lipoprotein
[HDL] cholesterol, and triglycerides)
82465 Cholesterol, serum, total
83718 Lipoprotein, direct measurement, high-density cholesterol
(HDL cholesterol)
84478 Triglycerides

Dyslipidemia Screening ICD-10-CM Code

Z13.220 Encounter for screening for lipid disorders

Hepatitis B Screening CPT Codes

86704 Hepatitis B core antibody (HBcAb); total
86705 IgM antibody
86706 Hepatitis B surface antibody (HBsAb)
86707 Hepatitis Be antibody (HBeAb)
87340 Infectious agent antigen detection by immunoassay technique
qualitative or semiquantitative hepatitis B surface antigen
(HBsAg)

30
Hepatitis B Screening ICD-10-CM Code
Z20.5 Contact with and (suspected) exposure to viral hepatitis
Z11.59 Encounter for screening for other viral diseases

Hepatitis C Screening CPT codes

86803 Hepatitis C antibody;
86804 Hepatitis C antibody; confirmatory test (eg, immunoblot)
87520 Infectious agent detection by nucleic acid (DNA or RNA);
hepatitis C, direct probe technique
87521 Infectious agent detection by nucleic acid (DNA or RNA);
hepatitis C, amplified probe technique, includes reverse
transcription when performed

Hepatitis C Screening ICD-10-CM Code

Z20.5 Contact with and (suspected) exposure to viral hepatitis
Z11.59 Encounter for screening for other viral diseases

Lead Screening CPT Code

83655 Lead

Lead Screening ICD-10-CM Code

Z13.88 Encounter for screening for disorder due to exposure to
contaminants

Newborn Metabolic Screening HCPCS Code

NOTE: See Healthcare Common Procedure Coding System Codes section

on page 34 for explanation of HCPCS codes.

S3620 Newborn metabolic screening panel, includes test kit, postage,

and the laboratory tests specified by the state for inclusion
in this panel (eg, galactose; hemoglobin, electrophoresis;
hydroxyprogesterone, 17-D; phenylalanine [phenylketonuria
(PKU)]; and thyroxine, total)

NOTE: Only report code S3620 if you are billing for the actual running of
the laboratory test or test kit. Otherwise only report the appropriate blood
collection code (eg, 36416).

31
Newborn Metabolic Screening ICD-10-CM Codes
Report the diagnosis codes for the state-specific newborn screening tests
conducted. Examples include
Z13.0 Encounter for screening for diseases of the blood and
blood-forming organs and certain disorders involving the
immune mechanism (eg, anemia, sickle cell)
Z13.21 Encounter for screening for nutritional disorder
Z13.228 Encounter for screening for other metabolic disorders
(eg, PKU, galactosemia)
Z13.29 Encounter for screening for other suspected endocrine
disorder (eg, thyroid)

Papanicolaou Smear HCPCS Code

NOTE: See Healthcare Common Procedure Coding System Codes section

on page 34 for explanation of HCPCS codes.

Q0091 Screening Papanicolaou smear; obtaining, preparing, and

conveyance of cervical or vaginal smear to laboratory
Papanicolaou Smear CPT Code
Collection of a cervical specimen via a pelvic examination is included in
the preventive medicine service code (99381–99385 and 99391–99395).

Papanicolaou Smear ICD-10-CM Codes

Z12.4 Encounter for screening for malignant neoplasm of cervix
(excludes HPV)
Z12.72 Encounter for screening for malignant neoplasm of vagina
Z12.79 Encounter for screening for malignant neoplasm of other
genitourinary organs
Z12.89 Encounter for screening for malignant neoplasms of other sites

Tuberculosis Testing (Mantoux/Purified Protein Derivative [PPD])

Administration of PPD Test
CPT Code ICD-10-CM Code
86580 Skin test; tuberculosis, Z11.1 Encounter for screening for
intradermal respiratory tuberculosis

NOTE: There is no separate administration code for the PPD test.

Do not report one.

32
Reading of PPD Test
If patient returns to have a nurse read the test results, report
CPT Codes ICD-10-CM Codes
99211 Office or other outpatient Z11.1 Encounter for screening
services (negative PPD for respiratory tuberculosis
outcome) (if test is negative)
99212– Office or outpatient services R76.11 Nonspecific reaction to
99215 (physician service for positive tuberculin skin tuberculosis
encounter) (if test is positive)

Sexually Transmitted Infection and HIV Screening CPT Codes

86701 Antibody; HIV-1
86703 Antibody; HIV-1 and HIV-2; single assay
87490 Infectious agent detection by nucleic acid (DNA or RNA);
Chlamydia trachomatis, direct probe technique
87491 Infectious agent detection by nucleic acid (DNA or RNA);
C trachomatis, amplified probe technique
87590 Infectious agent detection by nucleic acid (DNA or RNA);
Neisseria gonorrhoeae, direct probe technique
87591 Infectious agent detection by nucleic acid (DNA or RNA);
N gonorrhoeae, amplified probe technique
87810 Infectious agent detection by immunoassay with direct
optical observation; C trachomatis
87850 Infectious agent detection by immunoassay with direct
optical observation; N gonorrhoeae

Sexually Transmitted Infection and HIV Screening ICD-10-CM Codes

Z11.3 Encounter for screening for infections with a predominantly
sexual mode of transmission (excludes HPV and HIV)
Z11.8 Encounter for screening for other infectious and parasitic
diseases (eg, chlamydia)

33
 HEALTHCARE COMMON PROCEDURE CODING SYSTEM CODES
▶ The HCPCS Level II codes are procedure codes used to report services
and supplies not included in the CPT nomenclature.
▶ Like CPT codes, HCPCS Level II codes are part of the standard
procedure code set under the Health Insurance Portability and
Accountability Act of 1996.
▶ Certain payers may require that HCPCS codes be reported in lieu of
or as a supplement to CPT codes.
▶ The HCPCS nomenclature contains many codes for reporting
nonphysician provider patient education, which can be an integral
service in the provision of pediatric preventive care.
▶ Examples of HCPCS Level II codes relevant to pediatric preventive
care include
S0302 Completed Early and Periodic Screening, Diagnosis, and
Treatment service (List in addition to code for appropriate
E/M service.)
S0610 Annual gynecologic examination; new patient
S0612 Annual gynecologic examination; established patient
S0613 Annual gynecologic examination, clinical breast examination
without pelvic examination
S0622 Routine examination for college, new or established patient
(List separately in addition to appropriate E/M code.)
S9444 Parenting classes, nonphysician provider, per session
S9445 Patient education, not otherwise classified, nonphysician
provider, individual, per session
S9446 Patient education, not otherwise classified, nonphysician
provider, group, per session
S9447 Infant safety (including cardiopulmonary resuscitation)
classes, nonphysician provider, per session
S9451 Exercise classes, nonphysician provider, per session
S9452 Nutrition classes, nonphysician provider, per session
S9454 Stress management classes, nonphysician provider, per session

34
Commonly Reported ICD-10-CM Codes for Pediatric Preventive Services
ICD-10-CM Special Coding
Code Descriptor Conventions
Encounter and Examination Codes
Z00.110 Newborn check under 8 days old Outpatient codes only
Z00.111 Newborn check 8 to 28 days old Outpatient codes only
Z00.121 Routine child health examination First-listed ICD-10-CM
with abnormal findings code only.
Z00.129 without abnormal findings
Z00.00 General adult medical examination First-listed ICD-10-CM
without abnormal findings code only.
Z00.01 with abnormal findings Typically used for patients
18 years and older
(payer policy).
Z02.0 Examination for admission to Not required in addition
educational institution to a Z00 code
Z02.4 Examination for driving license
Z02.5 Examination for participation in sport
Z01.110 Hearing examination following First-listed ICD-10-CM
failed hearing screening code only. Do not report
as a secondary code or
in addition to a Z00 code.
Z23 Immunizations This is the only code in
ICD-10-CM for vaccines.
Link to both the product
and administration
CPT codes.
Z29.3 Encounter for prophylactic fluoride
administration

35
Commonly Reported ICD-10-CM Codes for Pediatric Preventive Services (continued)
ICD-10-CM Special Coding
Code Descriptor Conventions
Screening Codes
A screening code is not necessary if the screening is inherent to a routine examination,
but it can be reported and oftentimes payers require it.
Z11.1 Respiratory tuberculosis
Z11.3 Infections with a predominantly sexual mode of
transmission (excludes HPV and HIV)
Z12.4 Malignant neoplasm of cervix (excludes HPV)
Z11.51 Human papillomavirus (HPV)
Z11.59 Other viral diseases (eg, Hep B)
Z12.79 Malignant neoplasm of other genitourinary organs
Z12.89 Malignant neoplasms of other sites
Z13.0 Diseases of the blood and blood-forming organs
and certain disorders involving the immune
mechanism (eg, anemia, sickle cell)
Z13.1 Diabetes mellitus
Z13.21 Nutritional disorder
Z13.220 Lipid disorders
Z13.228 Other metabolic disorders (eg, inborn errors of
metabolism, galactosemia, PKU)
Z13.29 Other endocrine disorder
Z13.31 Depression screening
Z13.39 Encounter for screening examination for other
mental health and behavioral disorders
(eg, alcoholism, suicide ideation)
Z13.41 Autism screening
Z13.42 Global developmental delays (milestones)
screening
Z13.88 Disorder due to exposure to contaminants
(eg, lead)
Z13.89 Other specified disorders (not listed here)

36
ICD-10-CM Special Coding
Code Descriptor Conventions
Preventive Counseling
Z71.3 Dietary surveillance and counseling
Z71.82 Exercise counseling
Z71.84 Health counseling related to travel
Z71.89 Other specified counseling
Z71.9 Counseling, unspecified
Underimmunized Status
Z28.3 Underimmunized status A status code is
informative and may
affect the course
of treatment and
its outcome. Report
when this is the case.
Vaccines Not Given
Z28.01 Acute illness
Z28.04 Allergy to vaccine or components
Z28.82 Caregiver refusal
Z28.02 Chronic illness or condition
Z28.03 Immune compromised state
Z28.21 Patient refusal
Z28.81 Patient had disease being vaccinated for
Z28.1 Religious reasons
Z28.89 Other reason
Z28.83 Vaccine was unavailable (eg, manufacturer delay)
Z28.20 Unspecified reason

37
Social Determinants of Health
When identified during a routine preventive medicine service encounter, either through
a formal screening instrument or surveillance, they should be addressed as appropriate
and coded for. Listed below are a few of the SDOH codes in the ICD-10-CM code set;
however, always refer to the larger code set for others. For more information on coding
for SDOH issues and services visit https://downloads.aap.org/AAP/PDF/SDOH.pdf.
Social Determinants Of Health
Abuse
T74.02- Child neglect or abandonment
T74.12- Child physical abuse
T74.22- Child sexual abuse
T74.32- Child psychological abuse
T74.52- Child sexual exploitation
T74.62- Child forced labor exploitation
Z62.81- Personal history of abuse in childhood
Z69- Encounter for mental health services for victim of abuse
Economic
Z59.5 Extreme poverty
Z59.6 Low income
Z59.7 Insufficient social insurance and welfare support
Family Issues
Z63.31 Absence of family member due to military deployment
Z63.32 Other absence of family member
Z63.4 Disappearance and death of family member
Z63.5 Disruption of family by separation and divorce
Z63.72 Alcoholism and drug addiction in family
Z63.79 Other stressful life events affecting family and household
Z62.82- Parent-child conflict
Z62.890 Parent-child estrangement NEC
Food & Water Issues
Z59.41 Food insecurity
Z58.6 Unsafe drinking-water supply
Living situation
Z62.21 Child in welfare custody
Z59.0- Homelessness
Z59.81 Housing instability

38
 Social Determinants Of Health
Z62.22 Institutional upbringing
Z62.29 Other upbringing away from parents
Social Issues
Z60.3 Acculturation difficulty
Z60.4 Social exclusion and rejection
Z60.5 Target of (perceived) adverse discrimination and persecution
- Indicates another character is required to complete the code.

Healthcare Effectiveness Data and Information Set Measures Related to

Pediatric Preventive Care
Measure Topic Measure Coding Options
Child and Adolescent At least 6 well-child examinations ICD-10-CM
Well-Care Visits: by 15 months of age Z00.110, Z00.111,
Well-Child Visits in Z00.121, Z00.129
the First 15 Months CPT
of Life (W15)
99381, 99382,
99391, 99392
Child and Adolescent One or more comprehensive ICD-10-CM
Well-Care Visits: well-child visits with a PCP Z00.121, Z00.129
Well-Child Visits in (per year) CPT
the Third, Fourth,
99382, 99392
Fifth, and Sixth Years
of Life (W34)
Child and Adolescent At least one annual ICD-10-CM
Well-Care Visits: comprehensive well-care Z00.00, Z00.01,
Adolescent Well-Care encounter (per year) for Z00.121, Z00.129
Visits (AWC) adolescents and young CPT
adults aged 12–21 years
99384, 99385,
99394, 99395
Lead Screening in By age 2 years, have had one or CPT
Children (LSC) more capillary or venous lead 83655
blood tests for lead poisoning
Chlamydia Screening Sexually active women aged CPT
in Women (CHL) 16–24 years who received at 87110, 87270,
least one chlamydia test 87320, 87490–87492,
each year 87810

39
Healthcare Effectiveness Data and Information Set Measures Related to
Pediatric Preventive Care (continued)
Measure Topic Measure Coding Options
Childhood By age 2 y, have Varies; refer to the
Immunization DTaP (4 doses) Commonly Administered
Status (CIS) and IPV (3 doses) Pediatric Vaccines table
Immunizations for MMR (1 dose) on pages 25–28 for
Adolescents (IMA) Hib (3 doses) specific vaccine codes.
Hep B (3 doses)
Varicella (1 dose)
Pneumococcal (4 doses)
Hep A (1 dose)
Rotavirus (2–3 doses)
Influenza (2 doses)
By 13th birthday, have
Meningococcal (1 dose)
(Ages 11–13 y)
Tdap (1 dose)
(Ages 10–13 y)
HPV (males/females) (2–3 doses)
(Ages 9–13 y)
Weight Assessment For those aged 3–17 years who ICD-10-CM
and Counseling for had an outpatient visit with a PCP Z68.51–Z68.54,a
Nutrition and Physical during the measurement year and Z71.3, Z02.5, Z71.82
Activity for Children/ had evidence of BMI percentile
CPT
Adolescents (WCC) documentation and counseling for
3000Fa
nutrition and/or physical activity
Abbreviations: BMI, body mass index; CPT, Current Procedural Terminology; DTaP, diphtheria, tetanus,
acellular pertussis; Hep A, hepatitis A; Hep B, hepatitis B; Hib, Haemophilus influenzae type b; HPV, human
papillomavirus; ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification;
IPV, inactivated poliovirus; MMR, measles, mumps, rubella; PCP, primary care practitioner; Tdap, tetanus,
diphtheria, acellular pertussis.
a
Body mass index codes should only be reported when there is a related condition (eg, obesity). Payers need to
accept 3000F in lieu of BMI ICD-10-CM codes for the BMI measure unless the patient has a related condition.

40
 This program is supported by the Health Resources and
Services Administration (HRSA) of the U.S. Department of
Health and Human Services (HHS) as part of an award totaling
TM $5,000,000 with 10 percent financed with non-governmental
sources. The contents are those of the author(s) and do not
necessarily represent the official views of, nor an endorsement,
by HRSA, HHS, or the U.S. Government. For more information,
please visit HRSA.gov.
 Also From Bright Futures!

Bright Futures Tool and Resource Kit, 2nd Edition

This online resource provides health care professionals with an organized and
integrated compilation of current forms and materials needed to perform a
well-child visit on one website. The new online platform allows easy access to
the core tools for health supervision visits, including previsit questionnaires,
visit documentation forms, parent and patient education handouts, and
additional documentation forms and AAP-developed educational resources.
Bright Futures: Guidelines for Health Supervision of Infants, Children,
and Adolescents, 4th Edition
This essential resource provides key background information and recommenda-
tions for themes critical to healthy child development along with well-child
supervision standards for 31 age-based visits—from newborn through 21 years.

Additional Pediatric Coding Resources From

the American Academy of Pediatrics

NEW EDITION!
Coding for Pediatrics 2022: A Manual for Pediatric Documentation and
Payment, 27th Edition
Code it right the first time—and avoid delays and costly denials—with this widely
used pediatric coding resource. This year’s updated 27th edition includes all
changes in CPT and ICD-10-CM codes—complete with expert guidance for their
application.
NEW EDITION!
Pediatric ICD-10-CM 2022: A Manual for Provider-Based Coding, 7th Edition
This convenient resource condenses the vast ICD-10-CM code set into 500+ pages
of pediatric-related codes and guidelines.
NEW EDITION!
AAP Pediatric Coding Newsletter™
This print and online monthly publication brings you proven coding strategies and
how-to help with your toughest coding and payment challenges!

To order these and other pediatric resources,

visit shop.aap.org.

BFNC.2022.CPPCFEB
3-362/0222