As reported in the October 2011 AAP Pediatric Coding Newsletter™, practices should not report Current Procedural Terminology (CPT®) codes that include the terminology “provided by a qualified nonphysician healthcare professional” in their definition unless the physician (or licensed nurse practitioner with his or her own provider number) performs and documents the service.

Prior to January 2012, CPT did not define a qualified nonphysician health care professional. The language implied that reporting of services was based on state scope-of-practice laws. The lack of a CPT definition for a qualified nonphysician health care professional left the appropriate use of many codes open to interpretation. As you may be aware, you are now precluded from reporting CPT codes 90460 and 90461 (immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional) when counseling is performed by clinical staff...

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