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The CPT® Code 90473 refers to the administration of an immunization via the intranasal or oral route, specifically for a single vaccine or a combination vaccine/toxoid. This procedure is applicable to patients who are over the age of 18, and it can be performed with or without a face-to-face encounter with a physician or other healthcare professional. Additionally, this code is relevant for administering a vaccine or toxoid to patients aged 18 or younger, even in the absence of face-to-face counseling by a healthcare provider. It is important to note that when multiple vaccines or toxoids are administered during the same encounter, the first vaccine/toxoid is coded with 90473, while any additional vaccines or toxoids given in that encounter should be coded with 90474. This coding structure ensures accurate billing and documentation for immunization services provided to patients.
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The administration of immunizations via the intranasal or oral route using CPT® Code 90473 is indicated for the following:
The procedure for administering a vaccine or toxoid using CPT® Code 90473 involves several key steps:
Post-procedure care following the administration of a vaccine using CPT® Code 90473 typically includes monitoring the patient for any immediate adverse reactions, although serious reactions are rare. Patients may be advised to stay in the healthcare setting for a short period after administration for observation. Additionally, the provider may offer information regarding potential side effects and the importance of follow-up vaccinations if applicable. It is also essential to ensure that the patient understands the need for any additional doses or boosters that may be required in the future.
| Short Descr | IMMUNE ADMIN ORAL/NASAL | Medium Descr | IM ADM INTRANSL/ORAL 1 VACCINE | Long Descr | Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid) | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service 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 | STV-Packaged Codes | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | O1G - Immunizations/Vaccinations | MUE | 1 | CCS Clinical Classification | 228 - Prophylactic vaccinations and inoculations |
This is a primary code that can be used with these additional add-on codes.
| 90472 | Add-on Code MPFS Status: Active Code APC N CPT Assistant Article 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) | 90474 | Add-on Code MPFS Status: Active Code APC N CPT Assistant Article Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) |
| 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. | 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | 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 | GZ | Item or service expected to be denied as not reasonable and necessary | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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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 (previously associated with 90473) 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. 91316 received FDA approval. |
| 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. |
| 2022-11-16 | Note | AMA guideline changed to include 91316 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2022-08-31 | Note | AMA guideline changed to include 91312, 91313, 91314, 91315 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2022-08-31 | Note | AMA guideline changed. 91312, 91313 received FDA approval effectively immediately |
| 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 & 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. 91300 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. |
| 2010-01-01 | Changed | Code description changed. |
| 2002-01-01 | Added | Code added |