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The CPT® Code 90472 refers to the administration of immunizations, specifically for each additional vaccine given during a single encounter. This code encompasses various methods of injection, including percutaneous, intradermal, subcutaneous, or intramuscular routes. It is applicable for patients over the age of 18, regardless of whether there is a face-to-face interaction with a healthcare provider. Additionally, this code can also be utilized for patients aged 18 or younger when a vaccine or toxoid is administered without any face-to-face counseling from a physician or healthcare professional. It is important to note that this code is used in conjunction with CPT® Code 90471, which is designated for the first vaccine administered during the same encounter. Therefore, when multiple vaccines are given, 90472 should be listed separately for each additional vaccine administered beyond the first.
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The CPT® Code 90472 is indicated for the administration of additional vaccines during a single patient encounter. The following conditions apply:
The procedure for administering vaccines under CPT® Code 90472 involves several key steps, which are outlined as follows:
After the administration of the vaccine(s) under CPT® Code 90472, the patient is typically advised on post-vaccination care. This may include instructions on potential side effects, such as soreness at the injection site, mild fever, or fatigue, which are common reactions. Patients are encouraged to report any unusual or severe reactions to their healthcare provider. Additionally, the provider may schedule follow-up appointments for any necessary booster doses or further immunizations, ensuring that the patient remains up-to-date with their vaccination schedule.
| Short Descr | IMMUNIZATION ADMIN EACH ADD | Medium Descr | IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE | Long Descr | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 5 - Incident To Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | O1G - Immunizations/Vaccinations | MUE | 8 | CCS Clinical Classification | 228 - Prophylactic vaccinations and inoculations |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 90460 | MPFS Status: Active Code APC B Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered | 90471 | MPFS Status: Active Code APC Q1 CPT Assistant Article Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) | 90473 | MPFS Status: Active Code APC Q1 CPT Assistant Article Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid) | G0008 | Medicare Coverage: Carrier Priced MPFS Status: Statutory exclusion (from MPFS, may be paid under other methodologies) APC S Administration of influenza virus vaccine | G0009 | Medicare Coverage: Carrier Priced MPFS Status: Statutory exclusion (from MPFS, may be paid under other methodologies) APC S Administration of pneumococcal vaccine | G0010 | Medicare Coverage: Carrier Priced MPFS Status: Statutory exclusion (from MPFS, may be paid under other methodologies) APC S Administration of hepatitis b vaccine |
| GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GA | Waiver of liability statement issued as required by payer policy, individual case | AT | Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942) | GZ | Item or service expected to be denied as not reasonable and necessary | CR | Catastrophe/disaster related | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | GC | This service has been performed in part by a resident under the direction of a teaching physician | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care | SL | State supplied vaccine | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | FP | Service provided as part of family planning program | GE | This service has been performed by a resident without the presence of a teaching physician under the primary care exception | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GX | Notice of liability issued, voluntary under payer policy | JG | Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | JW | Drug amount discarded/not administered to any patient | JZ | Zero drug amount discarded/not administered to any patient | KX | Requirements specified in the medical policy have been met | LT | Left side (used to identify procedures performed on the left side of the body) | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SA | Nurse practitioner rendering service in collaboration with a physician | SK | Member of high risk population (use only with codes for immunization) | TR | School-based individualized education program (iep) services provided outside the public school district responsible for the student | TW | Back-up equipment | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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Date
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Action
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Notes
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|---|---|---|
| 2025-01-01 | Note | First appearance of guideline changes in codebook. |
| 2024-01-01 | Note | First appearance of updated 2022 guidelines in codebook |
| 2023-11-01 | Note | AMA guideline changed to include 91304, 91318, 91319, 91320, 91321, 91322 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2023-11-01 | Note | Note: AMA Guideline changed. These codes have been deleted from the guidelines: 91300-91317. |
| 2023-04-18 | Note | These codes (included in the guidelines) are no longer authorized for use in the United States: 91300, 91301, 91305, 91306, 91307, 91308, 91309, and 91311 |
| 2023-01-01 | Note | First appearance of guideline change(s) in codebook. |
| 2022-12-08 | Note | AMA guideline changed to include 91317. Published to website 2021-12-09. Received FDA approval effective retroactively to 2022-12-08. |
| 2022-12-08 | Note | AMA Guideline changed. 91316 received FDA approval. |
| 2022-11-16 | Note | AMA guideline changed to include 91316 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2022-10-12 | Note | AMA Guideline changed. 91315 received FDA approval. |
| 2022-08-31 | Note | AMA Guideline changed. 91312, 91313 received FDA approval effectively immediately. |
| 2022-08-31 | Note | AMA guideline changed to include 91312, 91313, 91314, 91315 effective upon receiving Emergency Use Authorization or approval from the FDA |
| 2022-07-13 | Note | AMA Guideline changed. 91304 received FDA approval. |
| 2022-06-17 | Note | AMA Guideline changed. 91308 & 91311 received FDA approval. |
| 2022-05-19 | Note | AMA guideline changed to include 91311 effective upon receiving Emergency Use Authorization or approval from the FDA |
| 2022-04-26 | Note | AMA guideline changed to include 91310 effective upon receiving Emergency Use Authorization or approval from the FDA |
| 2022-03-29 | Note | AMA Guideline changed. 91309 received FDA approval. |
| 2022-03-07 | Note | AMA guideline changed to include 91309 effective upon receiving Emergency Use Authorization or approval from the FDA |
| 2022-02-01 | Note | AMA guideline changed to include 91308 effective upon receiving Emergency Use Authorization or approval from the FDA |
| 2022-01-01 | Note | First appearance of 2020-2021 AMA guideline changes in codebook. |
| 2021-10-29 | Note | AMA Guideline changed. 91305 and 91307 received FDA approval. |
| 2021-10-20 | Note | AMA Guideline changed. 91306 received FDA approval. |
| 2021-10-06 | Note | AMA guideline changed to include 91307 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2021-09-03 | Note | AMA guideline changed to include 91305 & 91306 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2021-05-04 | Note | AMA guideline changed to include 91304 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2021-02-27 | Note | AMA Guideline changed. 91303 received FDA approval. |
| 2021-01-19 | Note | AMA guideline changed to include 91303 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2020-12-18 | Note | AMA Guideline changed. 91301 received FDA approval. |
| 2020-12-17 | Note | AMA guideline changed to include 91302 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2020-12-11 | Note | AMA Guideline changed. 91300 received FDA approval. |
| 2020-11-10 | Note | AMA guideline changed to include 91300 & 91301 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2013-01-01 | Changed | Guideline information changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2005-01-01 | Changed | Code description changed. |
| 2002-01-01 | Changed | Code description changed. |
| 1999-01-01 | Added | First appearance in code book in 1999. |