Code 99211 should not be reported for every nurse-only vaccine administration patient encounter. Rather, careful consideration needs to be given concerning the significance and medical necessity for such a visit.

When vaccines are given in the pediatric office, questions often arise concerning the reporting of evaluation and management (E/M) services performed during the same visit as the administration of vaccines. The answer always depends on whether the provider performs a medically necessary, significant, separately identifiable E/M service in addition to the immunization administration. If such a service is performed, an E/M code is reported, most likely from the 99201–99215 code family (office or other outpatient service), in addition to the appropriate code for immunization administration (90465–90468 or 90471–90474) and the code for the vaccine product(s). In these cases, payers may require modifier -25 (significant, separately identifiable E/M service performed by the same physician on the same day of...

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