Need help choosing the right code?
Ask CasePilot about procedures, modifiers, bundling, and coding guidance.
Try CasePilot© Copyright 2026 American Medical Association. All rights reserved.
The CPT® Code 90474 refers to the administration of immunizations via intranasal or oral routes, specifically for each additional vaccine administered beyond the primary procedure. This code is applicable when a patient, regardless of age, receives a single vaccine or a combination vaccine/toxoid. It is important to note that this administration can occur with or without a face-to-face encounter with a healthcare professional. For patients over the age of 18, the administration may not require direct interaction with a physician or other healthcare provider. Additionally, this code is also relevant for patients aged 18 or younger when the vaccine/toxoid is given without the necessity of face-to-face counseling. To accurately report the immunization process, the primary vaccine administration is coded using 90473, while 90474 is designated for each subsequent vaccine/toxoid administered during the same visit. This structured approach ensures proper documentation and billing for immunization services provided to patients.
© Copyright 2026 Coding Ahead. All rights reserved.
The CPT® Code 90474 is indicated for the administration of additional vaccines or toxoids when a patient is receiving immunizations via intranasal or oral routes. The following conditions or scenarios warrant the use of this code:
The procedure for administering vaccines under CPT® Code 90474 involves several key steps that ensure proper delivery and documentation of the immunization process. Each step is crucial for compliance and accurate billing:
Following the administration of vaccines coded under CPT® 90474, it is important to monitor the patient for any immediate side effects or adverse reactions, which may include mild symptoms such as nasal congestion or gastrointestinal discomfort, depending on the vaccine type. Documentation of the administration and any observed reactions should be recorded in the patient's medical record. Additionally, the healthcare provider may provide the patient with information regarding potential side effects and when to seek further medical attention. This ensures that the patient is well-informed and can report any concerns that may arise after the immunization. Proper follow-up care and documentation are essential for maintaining compliance and ensuring patient safety.
| Short Descr | IMMUNE ADMIN ORAL/NASAL ADDL | Medium Descr | IM ADM INTRANSL/ORAL EA VACCINE | Long Descr | Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | O1G - Immunizations/Vaccinations | MUE | 1 | CCS Clinical Classification | 228 - Prophylactic vaccinations and inoculations |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 90460 | MPFS Status: Active Code APC B Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered | 90471 | MPFS Status: Active Code APC Q1 CPT Assistant Article Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) | 90473 | MPFS Status: Active Code APC Q1 CPT Assistant Article Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid) | G0008 | Medicare Coverage: Carrier Priced MPFS Status: Statutory exclusion (from MPFS, may be paid under other methodologies) APC S Administration of influenza virus vaccine | G0009 | Medicare Coverage: Carrier Priced MPFS Status: Statutory exclusion (from MPFS, may be paid under other methodologies) APC S Administration of pneumococcal vaccine | G0010 | Medicare Coverage: Carrier Priced MPFS Status: Statutory exclusion (from MPFS, may be paid under other methodologies) APC S Administration of hepatitis b vaccine |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2025-01-01 | Note | First appearance of guideline changes in codebook. |
| 2024-01-01 | Note | First appearance of updated 2022 guidelines in codebook |
| 2023-11-01 | Note | Note: AMA Guideline changed. These codes have been deleted from the guidelines: 91300-91317. |
| 2023-11-01 | Note | AMA guideline changed to include 91304, 91318, 91319, 91320, 91321, 91322 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2023-04-18 | Note | These codes (previously associated with 90474) are no longer authorized for use in the United States: 91300, 91301, 91305, 91306, 91307, 91308, 91309, and 91311 |
| 2023-01-01 | Note | First appearance of guideline change(s) in codebook. |
| 2022-12-08 | Note | AMA Guideline changed. 91316 received FDA approval. |
| 2022-12-08 | Note | AMA guideline changed to include 91317. Published to website 2021-12-09. Received FDA approval effective retroactively to 2022-12-08. |
| 2022-11-16 | Note | AMA guideline changed to include 91316 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2022-08-31 | Note | AMA guideline changed 91312, 91313 received FDA approval effectively immediately. |
| 2022-08-31 | Note | AMA guideline changed to include 91312, 91313, 91314, 91315 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2022-07-13 | Note | AMA guideline changed. 91304 received FDA approval. |
| 2022-06-17 | Note | AMA guideline changed. 91308 & 91311 received FDA approval. |
| 2022-05-19 | Note | AMA guideline changed to include 91311 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2022-04-26 | Note | AMA guideline changed to include 91310 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2022-03-29 | Note | AMA guideline changed. 91309 received FDA approval. |
| 2022-03-07 | Note | AMA guideline changed to include 91309 effective upon receiving emergency Use Authorization or approval from the FDA. |
| 2022-02-01 | Note | AMA guideline changed to include 91308 effective upon receiving emergency Use Authorization or approval from the FDA. |
| 2022-01-01 | Changed | First appearance of 2020-2021 AMA guideline changes in codebook. |
| 2021-10-29 | Note | AMA Guideline changed. 91305 and 91307 received FDA approval. |
| 2021-10-20 | Note | AMA Guideline changed. 91306 received FDA approval. |
| 2021-10-06 | Note | AMA guideline changed to include 91307 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2021-09-03 | Note | AMA guideline changed to include 91305, 91306 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2021-05-04 | Note | AMA guideline changed to include 91304 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2021-02-27 | Note | AMA Guideline changed. 91303 received FDA approval. |
| 2021-01-19 | Note | AMA guideline changed to include 91303 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2020-12-18 | Note | AMA Guideline changed. 91301 received FDA approval. |
| 2020-12-17 | Note | AMA Guideline changed. 91302 effective upon receiving EUA or approval from the FDA. |
| 2020-12-11 | Note | AMA Guideline changed. 91300 received FDA approval. |
| 2020-11-10 | Note | AMA guideline changed to include 91300 & 91301 effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2013-01-01 | Changed | Guideline information changed. |
| 2002-01-01 | Added | Code added |
Get instant expert-level medical coding assistance.