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  • Screening Form For Adult Immunization: Pneumococcal, Tdap Or Zoster Vaccine

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Screening Form for Adult Immunization: Pneumococcal, Tdap or Zoster Vaccine Date: Name: LastFirstDOB: Over 65?MIYNMaleFemaleAddress: StreetPhone: (City) StateZipDoctors Name & Clinic: PLEASE ANSWER.

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A face-to-face service where a physician or other qualified health care professional (qualified per state licensure) provides counseling to the patient and/or caregivers is required to report 90460-90461. In the absence of counseling, the administrations must be reported with codes 90471-90474.

The 90460 code is used when a physician is present and performs face-to-face counseling to the caregiver or parent. This code can only be used for patients through age 18. Code 90471 is used when the drug is administrated by a medical assistant or nurse and the patient does not see the physician at all.

CPT® range 90471 — 90474 identifies vaccines without Counseling (over 18 years of age) CPT® range 90460 — 90461 identifies vaccines with Counseling (thru age 18)

CPT code 90471 is reported for one vaccine and CPT code 90472 for each additional vaccine (single or combination vaccine/toxoid). Be sure to append modifier 25 to a separate E/M service provided on the same day as the vaccine, under CPT guidelines.

Pneumococcal vaccinations and flu shots The CPT codes for the pneumococcal vaccine are 90669 and 90732.

Has the person to be vaccinated ever received a dose of COVID-19 vaccine? If yes, which vaccine product was administered? How many doses of COVID-19 vaccine were administered? Did you bring the vaccination record card or other documentation?

90471 Immunization administration (includes percutaneous, intradermal, subcutaneous or intramuscular injection(s); one vaccine (single or combination vaccine/toxoid.

Report CPT code 90460 for the first or only vaccine/toxoid component. Report CPT code 90461 for each additional component. These codes report immunization administration to patients 18 years of age or younger. Use 90460 for each vaccine administered.

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© Copyright 1997-2025
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3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232