AAP Immunization FAQs

The AAP published its 2026 immunization schedule, which is based on the best available science in January 2026. A family-friendly version of the AAP schedule is also available on HealthyChildren.org.  

Families may have many questions regarding the recent news regarding the CDC changes to the childhood immunization schedule. See this Clinician-Family Immunization Communication FAQ which provides clinicians with ways to frame conversations in response to these questions. Additional articles and resources on common immunization questions for families are available on www.healthychildren.org/immunizations in English and Spanish.

Having immunization clinical decision support at the point of care is important to guide clinicians on the immunizations due for each patient. The AAP has been proactively working with partner organizations, EHR vendors, and others to facilitate incorporation of AAP immunization recommendations into the clinical decision support logic built int0 EHR systems. The American Immunization Registry Association (AIRA) has developed Clinical Decision Support (CDS) Supporting Data designed to help translate immunization recommendations into structured information that Immunization Information Systems (IIS), EHRs, and other clinical systems can implement. Additional information can be found here.
 
AAP and other professional societies have provided immunization recommendations to implementation partners such as AIRA early in the recommendation release process to inform the guidance document. 

The shared clinical decision-making recommendation provides a payment pathway for vaccines that are no longer routinely recommended by the CDC. Additionally, the Vaccines for Children (VFC) program would continue to distribute vaccines that have a shared clinical decision making recommendation for those that want it. 

Immunization coding is based on who provided counseling and when the counseling occurred:

• If counseling was provided by a physician, physician assistant, or nurse practitioner on the same date as the administration of the immunization, codes 90460 and 90461 representing counseling and administration would be reported. Multiple units of each code may be appropriate depending on how many different products are administered and the number of components in each injection.
• If counseling was provided by clinical staff or occurred on a previous date of service by a physician, physician assistant, or nurse practitioner such as when immunizations need to be split up on different dates for clinical reasons or if a practice has a separate immunization clinic day, codes 90471 and 90472 representing administration of the first injection and any additional injections administered would be reported.

When reporting codes 90460/90461 or 90471/90472, it’s important to remember that how you choose the codes and the number of units reported can differ based on the code set. If a physician, physician assistant, or nurse practitioner provides counseling on the same day as the immunization administration, the code selection is based on the number of components in the immunization given. However, if clinical staff provide counseling during a preventive visit or if the counseling is done by a physician, physician assistant, or nurse practitioner on a different day, then the code selection is based on the number of injections, or "per poke." See the AAP immunization coding table and preventive coding guide for additional information on reporting immunization administration.

Standalone immunization counseling utilizes three CPT codes: 90482, 90483, and 90484. The selection of the appropriate code is determined by the total time spent on counseling. It is important to note that only the time spent addressing refused immunizations can be included in the total time calculation. Additionally, some payers may require different codes instead of 90482, 90483, or 90484. For more information, refer to our factsheet on standalone immunization counseling.

When reporting counseling—whether it involves the administration of an immunization—it is essential to perform and document the following:
List all vaccine components

• Who provided counseling, either a physician, a physician assistant, a nurse practitioner, or a clinical staff member
• Discussion of questions or concerns raised by parents or caregivers
• Reason for refusal of immunization(s)

A brief overview and providing the parent or caregiver with a vaccine information statement does not constitute immunization counseling according to CPT definitions.

Additional information about coding and payment for immunizations can be found on the AAP Vaccine Financing and Coding page. Please report any payer concerns or hassles to the Coding & Payment Hotline.

To view questions and answers related to COVID-19 vaccination, see COVID-19 Vaccine Frequently Asked Questions.

The AAP’s recommendations regarding hepatitis B vaccination have not changed in response to the CDC immunization schedule changes. The AAP continues its current recommendation for the birth dose of hepatitis B vaccine for newborns within the first 24 hours of life.  Additionally, AAP continues to recommend subsequent hepatitis vaccine doses between 1-2 months and 6-18 months.  

• AAP Immunization Schedule
• Elimination of Perinatal Hepatitis B: Providing the First Vaccine Dose Within 24 Hours of Birth | Pediatrics | American Academy of Pediatrics
• AAP Red Book Chapter: Hepatitis B 

The AAP does not recommend serology testing for infants to guide further Hep B vaccination, as the significance of Hep B sAb level of >10 mIU/mL in early infancy is unknown.  There is also insufficient evidence regarding the significance of antibody levels obtained mid-series and the relationship with long-term immunity against hepatitis B, particularly in this age group. These laboratory results would not reliably represent immune status or a scientific basis for a decision to continue or forego subsequent vaccination. This laboratory test represents an unnecessary blood test and procedure for infants, a barrier for families, additional costs, a risk for immunity delay, and other potential harms to infants without conferring value for evidence-based decision making in a clinical setting. 

• Hepatitis B infection in infancy results in more serious disease burden: Around 90% of newborns infected with hepatitis b virus (HBV) develop chronic infection, compared to < 5% of adults infected later in life. But the birth dose eliminates this risk. People who were infected with hepatitis B at birth and are not treated have up to a 25% lifetime risk of developing liver cancer.
• Chronic hepatitis B infection remains a major health issue, as roughly 660,000 people in the US live with chronic hepatitis b infection and are often undiagnosed. This infection can easily be transmitted to others as the virus can live on surfaces outside of the body for more than 7 days.
• Risk-based screening has proven unsuccessful in the US, as there are real-world gaps and limitations in screening. Current data show that 12-18% of pregnant people don’t receive hepatitis B surface antigen (HBsAg) testing and only 35% of those who test positive receive all recommended follow-up care. Additionally, about 35-65% of HBsAg-positive mothers had no identifiable risk factors that would flag them for targeted screening.
• Universal screening works and the vaccine is safe. The universal hepatitis B vaccination program has resulted in a 99% decline in pediatric cases. The hepatitis B vaccinees have undergone randomized controlled trials including those with placebo-controlled designs, which have been summarized by CIDRAP’s Vaccine Integrity Project.  Additionally, the vaccine has a long-standing and proven safety record. 

Risk-based strategies were tried throughout the 1980s in the US and failed to reduce incidence of infant infection. CDC data showed that 30–40% of hepatitis B patients had no identifiable risk factors, meaning targeted approaches would never reach them. Similarly, 35–65% of HBsAg-positive mothers had no identifiable risk factors and would never be flagged under targeted screening programs. 

Implementation of an effective risk-based vaccination strategy based on maternal screening results is dependent upon universal maternal screening of HBsAg. Current data show that 12–18% of pregnant women don't receive HBsAg testing. Of those who test positive, only 35% receive all recommended follow-up care. The fragmented US healthcare system is not set up to catch everyone through risk-based vaccination approaches. The US shifted to universal infant vaccination in 1991, which has resulted in a 99% decrease in infant hepatitis infections. 

Countries without a universal birth dose recommendation have smaller populations, high rates of universal prenatal screening, and high rates of adherence to recommended follow-up care. 

The following are key steps appropriately administering the birth dose of hepatitis B vaccine based on AAP policy:

• Identify HBsAg-positive mothers before delivery and document maternal HBsAg status in infant records;
• Resolve unknown HBsAg status of mothers as soon as possible around delivery, and document maternal status in infant records;
• For all infants born to HBsAg-positive mothers, administer both hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 12 hours of birth, regardless of any maternal antenatal treatment with antiviral medications;
• For all infants with birth weight greater than or equal to 2000 g born to HBsAg-negative mothers, administer hepatitis B vaccine as a universal routine prophylaxis within 24 hours of birth;
• For all infants with birth weight less than 2000 g born to HBsAg-negative mothers, administer hepatitis B vaccine as a universal routine prophylaxis at 1 month of age or at hospital discharge (whichever is first);
• For all infants born to HBsAg-unknown mothers, administer hepatitis B vaccine within 12 hours of birth, and:
  • For infants with birth weight greater than or equal to 2000 g, administer HBIG by 7 days of age or by hospital discharge (whichever occurs first) if maternal HBsAg status is confirmed positive or remains unknown;
  • For infants with birth weight less than 2000 g, administer HBIG by 12 hours of birth unless maternal HBsAg status is confirmed negative by that time;
• Document infant vaccination accurately in birth hospital records and in the appropriate CDC Immunization Information Systems and state immunization registry. Review documentation accuracy periodically and address identified errors.

• Why Do Babies Need the Hepatitis B Vaccine? - HealthyChildren.org is an article for families and is available in Spanish
• Fact Checked: Hepatitis B Vaccine Given to Newborns Reduces Risk of Chronic Infection summarizes key facts about the importance of the birth dose
• Maternal and Infant Immunization Discussion Guides include talking points for clinicians and family-friendly infographics about Hepatitis B and other recommended immunizations that can be shared during patient encounters or outside the clinical visit

The AAP recommends routine vaccination against measles and early vaccination during special circumstances.  

The AAP recommends individuals receive 2 doses of measles, mumps, rubella (MMR) or measles, mumps, rubella and varicella (MMRV) vaccine. Routine timing for these vaccines are at the following ages

• Dose 1: 12 – 15 months
• Dose 2: 4 – 6 years 

The minimum interval is 28 days for MMR and 90 days for MMRV.  

Vaccination is the most effective way to prevent measles. A dose of measles vaccine administered after 12 months of age results in immunity in 93% of people. The 2nd dose increases immunity to 97%.

Since the introduction of measles vaccine in the United States in 1963, with millions of MMR doses being administered, transmission of measles through the MMR vaccine has not occurred for anyone (immunocompetent or immunocompromised).    

The routine vaccination series is for the 1st dose of MMR to be administered at 12-15 months of age with the 2nd dose at 4-6 years of age.  See information below on domestic measles outbreaks from the AAP Red Book.

Health care providers should follow vaccination recommendations issued by the state, local, tribal, or territorial health departments for areas experiencing sustained, community-wide measles transmission and an ongoing risk of exposure. In some cases, additional vaccinations may be recommended beyond the routine MMR vaccination schedule. For example, health departments may recommend:

• A second dose of MMR vaccine for preschool-aged children aged 1 to 4 years who received one prior dose and live in or plan to travel to the outbreak area. Children with no documentation of vaccination history should receive two doses, at least 28 days apart.
• An early dose of MMR vaccine for infants aged 6–11 months who live in or are traveling to the outbreak area.
  • Providers should weigh the benefit of protection from measles during an outbreak against the risk of decreased immune responses in infants vaccinated with MMR before 12 months of age.
  • Infants younger than 12 months of age are at greatest risk of severe illness. Vaccination of infants aged 6–11 months minimizes the risk of disease and death that could occur in these infants during measles outbreaks.
  • The level of protective antibodies is lower and may remain lower in children vaccinated at younger than 12 months of age than in children vaccinated later. Infants who receive one dose of MMR vaccine before their first birthday should receive two more doses according to the routinely recommended schedule (one dose at 12 through 15 months of age and another dose at 4 through 6 years of age or at least 28 days later). (For additional information, see: 2025_providerletter_mmrtravelandoutbreakrecs.pdf section: “Immune Response to Measles Vaccination”.)

Vaccination of visitors to outbreak-affected areas should be consistent with the guidance of the state, local, tribal, or territorial health department for residents of the outbreak-affected community. For example, if no vaccination recommendation was made by the local health department for infants aged 6–11 months living in the outbreak community, then vaccination of infant travelers visiting the outbreak area would also not be recommended. Healthcare providers can find updated outbreak recommendations issued by state or local health departments on local web sites or the Red Book Online Outbreaks page.

MMR can be used as post-exposure prophylaxis if administered < 72 hours after measles exposure in individuals 6 months of age and older who do not have evidence of measles immunity.

Providers should weigh the benefit of protection from measles during an outbreak against the risk of decreased immune responses in infants vaccinated with MMR before 12 months of age.

Infants younger than 12 months of age are at greatest risk of severe illness. Vaccination of infants aged 6–11 months minimizes the risk of disease and death that could occur in these infants during measles outbreaks.

The level of protective antibodies is lower and may remain lower in children vaccinated at younger than 12 months of age than in children vaccinated later. Infants who receive one dose of MMR vaccine before their first birthday should receive two more doses according to the routinely recommended schedule (one dose at 12 through 15 months of age and another dose at 4 through 6 years of age or at least 28 days later). (View additional information, see section “Immune Response to Measles Vaccination”.)

AAP is not aware of claims denials for early MMR vaccination following public health guidelines.  Please contact the AAP Coding and Payment Hotline for support in addressing coding and payment-related questions or if you experience a payment denial. 

According to Immunize.org, adults are considered to have presumptive evidence of immunity to measles if they have written documentation of at least 1 dose of MMR vaccine on or after their 1st birthday, written documentation of 2 doses of MMR vaccine for individuals at high risk, laboratory evidence of measles immunity, laboratory confirmation of measles infection, or birth before 1957.  

During measles outbreaks, health departments may provide additional recommendations to protect their communities, including a second dose of MMR for adults who have received only 1 dose previously. During an outbreak of measles in a healthcare facility, or in healthcare facilities serving a measles outbreak area, two doses of MMR vaccine are recommended for healthcare personnel, regardless of birth year, who lack other presumptive evidence of measles immunity. There are no recommendations to receive a third dose of MMR vaccine during measles outbreaks.

Please see Measles FAQ’s for additional information specific to measles infection prevention and control.

To view questions and answers related to RSV immunization, see RSV Immunization Frequently Asked Questions.