Coding for Preventive Screenings
Preventive screenings are covered by most payers without patient cost-sharing, but they must be billed correctly. Use specific Z-codes to indicate a screening purpose, such as Z13.1 for diabetes screening or Z00.00 for a general adult health check. These screenings are often part of an Annual Wellness Visit or physical but can sometimes be billed as a standalone nurse visit if that is all the patient is seen for.
Immunization Billing (Flu, Pneumonia, COVID-19)
Billing for vaccines requires two separate codes on the claim: one for the vaccine product itself (the CVX or CPT code for the specific vaccine) and one for the administration (e.g., 90471 for a single injection). For COVID-19 vaccines, use the specific administration codes released by CMS and other payers. Forgetting to bill both the product and the administration is a very common and costly error.
Counseling Component: If vaccine counseling is provided to a patient under 18, use codes 90460-90461 for the administration, which includes reimbursement for the counseling component.
