Immunization administration (includes percutaneous, intradermal, subcutaneous, intramuscular, and jet injection); each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure)

CPT 90472 is the billing code for "Immunization administration (includes percutaneous, intradermal, subcutaneous, intramuscular, and jet injection); each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure)". Each additional vaccine administration without counseling (any age)

Medicare pays approximately $14.23 for CPT 90472 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.

CPT 90472 has a total RVU of 0.37, broken down as: Work RVU 0.15, Practice Expense RVU 0.20, and Malpractice RVU 0.02. RVUs (Relative Value Units) determine Medicare reimbursement rates.

The most common denial reason for CPT 90472 is "Billed without primary code 90471 - add-on code requires base code". 90472 is add-on code for each additional vaccine (second, third vaccine same visit). Cannot bill 90472 without 90471 as first vaccine. Denials occur when only 90472 submitted without corresponding 90471 on claim. Common causes include: Multiple vaccines given - only additional vaccines billed, forgot first vaccine; Billing software error - 90471 not included on claim with 90472. Appeal success rate is approximately 70-80%.

Key documentation requirements for CPT 90472 include: Each additional vaccine documented; Route of administration documented; Patient response to vaccination. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 90472: Each additional vaccine. Add-on code Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 90472 include: 59 (Distinct procedural service when multiple procedures performed). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 90472 is Typically 3-5 minutes per additional vaccine. Time-based codes require documentation of the actual time spent providing the service.