Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)

CPT 90473 is the billing code for "Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)". First or only vaccine administration via intranasal or oral route

Medicare pays approximately $16.17 for CPT 90473 (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 90473 has a total RVU of 0.44, broken down as: Work RVU 0.17, Practice Expense RVU 0.25, and Malpractice RVU 0.02. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 90473 include: Vaccine administered documented; Route documented (intranasal or oral); Patient response to vaccination. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 90473: First or only vaccine. Intranasal or oral route only Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 90473 include: 59 (Distinct procedural service when multiple procedures performed), 25 (Significant, separately identifiable evaluation and management service). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 90473 is Typically 3-5 minutes. Time-based codes require documentation of the actual time spent providing the service.