Optimizing Reimbursement for Routinely Recommended Maternal Immunizations

Published March 2026

Immunizations are recommended as part of comprehensive care for pregnant people. Obstetrician–gynecologists have a unique opportunity to reduce the frequency of vaccine-preventable diseases with

• awareness of current vaccine recommendations
• education and encouragement of their patients to receive appropriate vaccines 
• integration of vaccination into routine clinical practice

ACOG encourages clinicians to stock and, ideally, administer all recommended vaccines in their offices. Studies show that immunization rates are higher when a trusted clinician can strongly recommend, offer, and administer the vaccine during the same visit, rather than recommending vaccination and referring the patient elsewhere for vaccination.

Influenza and Tdap vaccines are routinely offered and administered by a majority of prenatal care practices, while other important vaccines are not as commonly stocked, leaving significant gaps in care. With proper documentation and coding, billing for both counseling about and administration of vaccines can be reported to third-party payers, and reimbursement can be received. In general, the appropriate vaccine product code, which is also specific to different manufacturers’ brands within a class of vaccines, should always be reported along with the appropriate Current Procedural Terminology (CPT) vaccine administration code for the vaccination procedure itself.

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Coding Tips

• Must include relevant ICD-10-CM codes indicating a vaccine was administered during a pregnancy visit, Z23 (vaccine encounter).
• Document the gestational age at the time of vaccination using the correct ICD-10-CM diagnosis codes (Z3A.X, X = gestational age in weeks). 
• Use the appropriate administration codes:
  • 90471 (for one vaccine in patients over age 18)
  • AND 90472 (for each additional vaccine given after the first one in the same visit in patients over age 18)

—OR—

• 90460 (for patients through 18 years of age or younger when  vaccine counseling is provided)
• AND 90461 (for each additional vaccine given after the first one in the same visit in patients in patients through age 18 or younger)

• Some payers may require modifier “-33” on the administration code to indicate the service was preventive and exempt from patient cost-sharing. Check payer coding guidelines.
• If distinct vaccine counseling beyond the standard administration is documented, an Evaluation and Management (E/M) visit code may also be billed.

Reimbursement for Vaccinations – Coding Formula

A vaccination procedure has two components: 1) the administration of the vaccine and 2) the vaccine product (drug) itself. The administration may be performed by the obstetrician–gynecologist or other health care professional. When the vaccine drug and the administration are provided by the physician’s office, report a code for the vaccine and a code for the administration of the vaccine.

• Formula: ICD-10-CM Code + Administration CPT Code + Vaccine-Specific CPT Code (different for each vaccine)
  
  • Z23 – Encounter for immunization (any) + 90480 + Vaccine-Specific CPT Code (See table below)
  • Z23 – Encounter for immunization (any) + 90460, 90461, 90471, 90472 + Vaccine-Specific CPT Code (See table below)

Table: Vaccines Commonly Administered to Pregnant Patients

Coding Scenarios

1. A 34-week pregnant woman is given the maternal RSV vaccine (Abrysvo). Which of the following are the correct ICD-10-CM codes for a routine prenatal visit with the administration of the RSV vaccine?
   1. Z34.83, Z3A.34
   2. Z34.32, Z24
   3. Z34.92, Z3A.32
   4. Z23, Z3A.34

2. A 30-year-old pregnant woman presents at 32 weeks of gestation to the clinic for the administration of the maternal RSV vaccine (Abrysvo). Which of the following are the correct CPT codes for the vaccine code and the administration of the vaccine?
   1. 96372, 90683
   2. 90460, 90679
   3. 90471, 90678
   4. 96380, 90381

3. A 25-year-old patient who is nulligravid presents for a routine prenatal care visit at 12 weeks of gestation. During this visit, the patient receives an influenza vaccination. Assuming the patient has a commercial payer, what is the appropriate set of CPT and ICD-10-CM codes to report the immunization administration and the encounter? Select all that apply.
   1. Z34.01, Z23, 90471, 90656
   2. Z3A.12, Z23, 90471, 90686
   3. Z23, 90472, 90686
   4. Z34.01, 90460, 90656

4. The patient from the previous scenario comes in for a routine prenatal appointment at 28 weeks of gestation. She is Rh-negative and is given antenatal Rho(D) immune globulin. She also receives her Tdap vaccination. Which of the following represents the most appropriate set of ICD-10-CM and CPT codes to report the Rho(D) immune globulin and the Tdap immunization (assuming commercial payer rules for coding)? Select all that apply.
   1. Z29.13, Z3A.28, 96372, 90384
   2. Z3A.12, 90460, 90715, 90384
   3. Z29.13, Z23, 96375, 90384
   4. Z34.03, Z23, Z3A.28, 90471, 90715

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