New for 2026: Coding for Immunization Counseling When Vaccines Aren't Given

Starting January 1st, 2026, your practice has new counseling codes available to report time spent counseling families about immunizations that ultimately are not administered at the visit. For independent pediatricians, this update recognizes a reality many face daily: meaningful, time-consuming vaccine conversations don’t always end with vaccination – with these updates, that work can be more accurately reflected in coding.

Here’s what you need to know to code, bill, and get paid for these important counseling conversations.

What’s New?

The AMA has introduced three new time-based codes, 90482–90484, to capture qualified health care professional counseling when one or more immunizations are not administered on the same date of service.

These codes are designed to account for counseling time only for vaccines not given, regardless of how many were discussed.

New Codes at a Glance (Effective 1/1/26)

• 90482 – Use for immunization counseling when immunizations are not administered and the counseling time lasts 3–10 minutes. If counseling lasts under 3 minutes, you should not bill this code.
• 90483 – Use for counseling more than 10 minutes, up to 20 minutes.
  
  
• 90484 – Use for counseling sessions lasting 20 minutes or longer.

Key points to keep in mind: only one of these codes may be billed per visit. They’re also cumulative time-based, regardless of the number of vaccines you discussed during the visit. Finally, the codes only apply to immunizations not administered. Vaccines counseled and administered should be billed separately.

Important Billing Rules to Consider

• Bill 90482–90484 only once per date of service, if applicable
  
  
• Do not include:
  
  
  • The time spent counseling for vaccines that were administered. Only include time spent for vaccines that were not administered.
    
    
  • Time already reported with immunization administration codes such as 90460, 90461, 90471–90474, 90480–90481, or 96380–96381
    
    
• If all vaccines are given, these new codes do not apply 

Diagnosis Coding

Commonly used ICD-10 options include:

• Z71.85 – Encounter for immunization safety counseling
  
  
  • May be coded alongside Z23 (encounter for immunization), if applicable
    
    
  • May also be coded with Z28.- when vaccines are not administered
    
    

Examples from the Z28.- category:

• Z28.82 – Immunization not carried out because of caregiver refusal
  
  
• Z28.310 – Unvaccinated for COVID-19
  
  
• Z28.89 – Immunization not carried out for other reason
  
  

(Practices should review the full Z28.- category to ensure the most accurate diagnosis selection.)

Using the New 2026 Admin Codes In Real Life

The following example vignette was created for educational use by Jan Blanchard, CPC, CPMA.

Scenario: A 2 month old patient is seen for a visit where they are scheduled to be given HepB, Pentacel, PCV15 and Rotateq. If we assume that a provider spends 2 minutes of time counseling for each vaccine component, how would the practice bill for the vaccine administrations if: 

1. All vaccines are administered?
2. No vaccines are administered?
3. Some vaccines are administered, some are not?

All Vaccinations Administered to 2m old: 

    HepB - 2 mins

    Pentacel - 2 mins x 5 components = 10 minutes

    PCV15 - 2 mins

    Rotateq - 2 mins

      Total.     16 mins

    Supply codes + 90460 x 4, 90461 x4

No Vaccinations Administered to 2m old: 

    HepB - 2 mins

    Pentacel - 2 mins x 5 components = 10 minutes

    PCV15 - 2 mins

    Rotateq - 2 mins

      Total.     16 mins

    90483 x 1 (16 billable minutes)

Some Vaccinations Administered to 2m old: 

    (A) HepB - 2 mins

    Pentacel - 2 mins x 5 components = 10 minutes

    (A) PCV15 - 2 mins

    Rotateq - 2 mins

      Total.     16 mins

    90483 x 1 (12 billable minutes), HepB & PCV15 Supply + 90460 x 2

Others Administered to 2m old: 

    HepB 2 - mins

    (A) Pentacel - 2 mins x 5 components = 10 minutes

    PCV15 - 2 mins

    (A) Rotateq - 2 mins

      Total.     16 mins

    90482 x 1 (4 billable minutes), Pentacel & Rotateq Supply + 90460 x 2, 90461 x 4

Why This Matters for Independent Practices

Vaccine counseling, especially when families are vaccine-hesitant or requesting a delayed schedule, is thoughtful, skilled clinical work. These new codes acknowledge that reality and give practices a clearer way to document and report that time, and be appropriately paid for that work.

As always, clear documentation of time spent and vaccines discussed will be essential. Consider reviewing these updates with both clinical and billing staff to ensure everyone understands how and when the new codes apply.

Would you like more examples and a chance to discuss these coding updates? Anyone interested in excellent pediatric billing is cordially invited to our monthly Billing Drop-In sessions to discuss this and many more billing topics with colleagues and billing experts. Additionally, PCC clients can access the PCC Community forum to discuss billing questions in real time with colleagues across the U.S.