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2025 CPT code 90472

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).

Refer to current CPT coding guidelines for specific instructions on reporting immunization administration codes, including rules for combination vaccines, multiple vaccines administered on the same day, and documentation requirements.

Modifiers may be applicable in certain circumstances (e.g., 52 for reduced services, etc.). Refer to current CPT guidelines for appropriate modifier usage.

Medical necessity for the additional vaccine administrations must be supported by the patient's age, immunization history, risk factors, and current health status. Adherence to the recommended immunization schedule and any specific medical indications for the vaccines should be documented.

The physician or other qualified healthcare professional is responsible for administering the additional vaccine injections, ensuring proper technique and following appropriate medical guidelines. They must select the correct vaccine, prepare it according to instructions, and administer it via the appropriate route (percutaneous, intradermal, subcutaneous, or intramuscular). They must also document the procedure, including the vaccine administered and the site and route of administration.

IMPORTANT:For the first immunization administered with counseling by physician or other qualified healthcare professional through 18 years of age, use 90460. For each additional vaccine/toxoid administered with counseling by a physician through 18 years of age, use 90461. If no physician counseling is provided, use 90471 for the first vaccine and 90472 for subsequent vaccines administered via injection. For intranasal or oral administration, use 90473 for the first vaccine and 90474 for each additional vaccine. For SARS-CoV-2 vaccines, use 90480.

In simple words: This code covers each additional shot of a vaccine given during the same visit, after the first shot. It's used for injections under the skin or into the muscle. It's billed separately from the code for the first vaccine.

This code is used for each additional vaccine or toxoid administered after the first one, and it includes percutaneous, intradermal, subcutaneous, or intramuscular injections. It should be listed separately in addition to the code for the primary procedure/first vaccine administered. For patients under 19, when physician counseling is provided, use 90461 instead. Do not report 90471, 90472 in conjunction with certain toxoid codes unless both a COVID-19 vaccine and at least one other vaccine from a specified range are administered at the same encounter.

Example 1: A 7-year-old child receives the MMR, Varicella, and DTaP vaccines during a single office visit. 90460 would be reported for the first component of each vaccine and 90461 x 5 for the remaining components assuming face-to-face counseling is performed by a physician., A 25-year-old patient receives both a flu shot and a tetanus booster during the same visit. 90471 would be billed for the first vaccine administered, and 90472 would be billed for the second vaccine., A 15-month-old child receives their second dose of the MMR vaccine. 90460 is reported assuming face-to-face counseling is provided by a physician or other qualified healthcare professional.

Documentation should include the date of service, the vaccine(s) administered (including name, manufacturer, lot number, and dosage), the route and site of administration for each vaccine, and any adverse reactions. If counseling was provided, it should also be documented. If applicable, insurance and vaccine program information should be recorded.

  • Modifier TC rule: No specific TC modifier applies to 90472, it is reported for the professional component.
  • Specialties:Family Medicine, Pediatrics, Internal Medicine, Public Health, General Practice
  • Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Public Health Clinic, Other Place of Service, Pharmacy
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