E&M 99213 + Vaccine admin 90471
E&M 99213 and vaccine administration 90471 bundle without modifier 25 on the E&M.
Why this pair bundles
Vaccine pre-counseling and consent are bundled into 90471. Separate E&M only if a significant separate evaluation occurred.
Modifier-bypass policy
Modifier indicator: 1 — modifier 59 / XE / XP / XS / XU permitted when supporting documentation is on file.
Modifier 25 on E&M when there's a distinct clinical issue beyond the vaccine encounter.
Documentation requirements
- Separate complaint or condition addressed
- Distinct HPI for non-vaccine issue
- Clear MDM for the separate condition
Common clinical scenarios
- Patient comes in for flu shot AND reports new symptoms requiring evaluation
- Annual physical with multiple vaccines plus E&M for chronic conditions
Frequently asked questions
Why does CMS bundle 99213 and 90471?
Vaccine pre-counseling and consent are bundled into 90471. Separate E&M only if a significant separate evaluation occurred.
When can I use modifier 59 (or X{EPSU}) to bypass?
Modifier 25 on E&M when there's a distinct clinical issue beyond the vaccine encounter.
What documentation supports separate billing?
Separate complaint or condition addressed; Distinct HPI for non-vaccine issue; Clear MDM for the separate condition.
When does this conflict typically arise?
Patient comes in for flu shot AND reports new symptoms requiring evaluation; Annual physical with multiple vaccines plus E&M for chronic conditions.
Related NCCI edits
- E&M 99213 + RPM treatment management (0780T equivalent)Remote physiologic monitoring services and same-day E&M generally do NOT bundle
- E&M 99213 + Joint injection 20610E&M and major joint injection (knee, shoulder, hip) bundle without modifier 25 o
- E&M 99213 + Venipuncture 36415Office E&M and routine venipuncture can be reported together — 36415 is separate
- E&M 99213 + Urine pregnancy test 81025Urine pregnancy test (POC) and office E&M can be reported together — 81025 is se
- E&M 99213 + ECG 93000Office E&M and complete ECG can be reported together but require modifier 25 on
- E&M 99213 + Pressurized inhalation (94640)E&M and nebulizer treatment bundle without modifier 25 on the E&M.
Sources
Catch NCCI 99213/90471 conflicts before submission
ApprovalHelp auto-flags NCCI bundling conflicts on the claim line before you submit. Modifier-bypass eligibility checked against current quarterly NCCI tables. no setup fee.
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