2025 CPT code 90474
(Active) Effective Date: N/A Revision Date: N/A Medicine - Immunization Administration for Vaccines/Toxoids Medicine Services and Procedures Feed
Administration of each additional live attenuated vaccine (single or combination vaccine/toxoid) via oral or intranasal route.This code is an add-on code and requires a primary administration code.
Modifiers may apply depending on the circumstances of service. Consult the CPT manual and payer specific guidelines.
Medical necessity is established by the physician's clinical judgment based on the patient's individual needs and the recommended immunization schedule.Documentation supporting the need for the additional vaccine must be present.
The physician or other qualified healthcare professional administers the additional vaccine(s) after preparing the patient. This includes counseling and administering the vaccine orally or intranasally.This code is only for the *additional* administration; the initial vaccine administration is billed separately.
In simple words: This code describes giving extra doses of a weakened live vaccine, either by mouth or nose spray, after the first dose.It's only used along with a code for the first dose, not on its own.
This CPT code, 90474, reports the administration of each additional live attenuated vaccine or combination of vaccines/toxoids given by the oral or intranasal route.This is an add-on code, meaning it must be reported in addition to a primary procedure code for the initial vaccine administration (e.g., 90460, 90471, or 90473).It should not be used with codes 91304, 91318-91322 unless both a SARS-CoV-2 vaccine/toxoid and at least one vaccine/toxoid from the 90476-90759 range are administered during the same encounter.
Example 1: A child receives the MMR vaccine (primary code). During the same visit, the physician also administers a live attenuated oral polio vaccine (90474).This is indicated by the parent, and the physician provides counseling., A patient receives a flu shot (primary code). The patient also receives a nasal influenza vaccine (90474) in the same visit. The physician provides proper counseling for both vaccines., An adult receives a COVID-19 vaccine (primary code using 90480).During that visit, they also receive a second live attenuated vaccine (oral or nasal) 90474.Note that 90474 is not usually used with COVID-19 vaccines.
Documentation should include the type of additional vaccine(s) administered, the route of administration (oral or intranasal), the date of administration, and the patient's age and medical history.Note that this code should also be supported by documentation for the primary administration procedure code that is also reported.
** Always refer to the most current CPT codebook and payer-specific guidelines for accurate coding and reimbursement.
- RVU: Information not available in provided text.Consult the current CPT codebook or a reliable medical billing resource for RVU information.
- Global Days: Not applicable to this add-on code.
- Payment Status: Active
- Modifier TC rule: Not applicable.This is an add-on code.
- Fee Schedule: Information not available in provided text.Consult a reliable medical billing resource for historical fee schedule data.
- Specialties:Pediatrics, Family Medicine, Internal Medicine, Infectious Disease
- Place of Service:Office, Clinic, Hospital (Inpatient or Outpatient)