CPT
90471 — Immunization administration, single vaccine
ACA-covered vaccines should be free, including the admin fee.
Telehealth
99423 — Online digital E/M, established patient; 21+ min cumulative over 7 days
This is the highest-level online digital E/M code, used when a physician spends 21 or more cumulative minutes over a 7-day period managing an established patient via secure electronic communication.
- Typical setting: Online (asynchronous)
- National avg charge (illustrative): $55-$95 Medicare allowed (approx. $55-$85 national Medicare average; commercial payers $75-$130)
- Most-disputed reason: Billing during a post-operative global period: 99423 cannot be billed during a surgical global period because online services are included in the global fee
What it means
What 99423 actually means
This is the highest-level online digital E/M code, used when a physician spends 21 or more cumulative minutes over a 7-day period managing an established patient via secure electronic communication. It is intended for complex situations requiring substantial clinical decision-making conducted through digital channels. It cannot be billed if an in-person visit occurs within the same 7-day window.
Common errors with this code
What goes wrong on real bills.
Most bills that look correct still contain at least one of these issues. Up to 49% of medical bills contain errors (CFPB).
- Billing during a post-operative global period: 99423 cannot be billed during a surgical global period because online services are included in the global fee
- Upcoding: billing 99423 for interactions that total less than 21 minutes without supporting documentation
- Billing for telehealth video visits using 99423: video-based telehealth visits are billed using appropriate office visit codes (99202-99215 or 99221-99239) — 99421-99423 are specifically for asynchronous digital communication
If you see 99423 on your bill
Three steps before paying.
1. Get the itemized bill. If your statement only shows a summary, request the CPT-level itemized bill before paying. Generate the request language →
2. Cross-check against the EOB. Compare what your insurer's Explanation of Benefits says you owe versus what the hospital is asking. They disagree more often than people think. Read the bill-vs-EOB guide →
3. Run a free Bill Scan. Upload the bill (and EOB if you have it) and BillBusted will flag the most likely issues with this specific code in your specific state. Run free scan →
Related codes
Other codes in this category.
People who land on 99423 often also see these adjacent codes on the same bill.
CPT
90472 — Immunization admin; each additional vaccine
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90651 — Human papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90670 — Pneumococcal conjugate vaccine, 13 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90671 — Pneumococcal conjugate vaccine, 15 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90677 — Pneumococcal conjugate vaccine, 20 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
Related BillBusted guides
Plain-English reads if you see 99423 on a bill.
99423 FAQ
Plain-English answers.
What does 99423 usually cost?
$55-$95 Medicare allowed (approx. $55-$85 national Medicare average; commercial payers $75-$130). Costs vary by region, payer contract, and whether the service was performed in a hospital outpatient department (which adds a facility fee) versus a free-standing clinic.
What's the most common billing error on 99423?
Billing during a post-operative global period: 99423 cannot be billed during a surgical global period because online services are included in the global fee
What should I do if I see 99423 on my bill?
Request the itemized bill and the matching EOB from your insurer. Compare the units/quantity billed against what you actually received. Run a free BillBusted scan to flag the most likely errors specific to 99423 before paying.
Don't pay 99423 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.