Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure)

CPT 90474 is the billing code for "Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure)". Each additional vaccine administration via intranasal or oral route

Medicare pays approximately $11.64 for CPT 90474 (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 90474 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.

Key documentation requirements for CPT 90474 include: Each additional vaccine 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 90474: Each additional vaccine. Add-on code Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 90474 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 90474 is Typically 3-5 minutes per additional vaccine. Time-based codes require documentation of the actual time spent providing the service.