CPT 90473: Live Attenuated Vaccine Administration, Intranasal or Oral
CPT code 90473 denotes the administration of a live attenuated vaccine by intranasal or oral route. This code captures non-injectable vaccine delivery performed by a provider and is relevant for tracking immunization services, ensuring correct billing, and aligning payer reimbursement with clinical practice. Live attenuated intranasal or oral vaccines play a role in preventive care and outbreak response, making accurate coding important for public health monitoring and practice revenue cycle management.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage patterns, reimbursement benchmarks where available, and how CPT code 90473 fits into vaccine administration workflows across outpatient ambulatory settings.
Readers will learn the clinical and billing context for CPT code 90473, typical sites of service, common modifiers and coding considerations (overview), and where to find additional coding guidance. The summary highlights how the code is used in practice, lists data elements that are available, and notes when input data is not provided. Data not available in the input is explicitly identified in relevant sections of the full publication.
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Billing Code Overview
CPT code 90473 represents administration of a live attenuated vaccine delivered via intranasal or oral route. The procedure involves the provider administering the vaccine to the patient using a non-injectable route.
Service type: Vaccine administration, live attenuated, intranasal or oral.
Typical site of service: Outpatient clinic, primary care office, urgent care, or other ambulatory settings where vaccinations are provided.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 3-year-old child presents to a pediatric clinic during influenza season for routine immunization. The child has no contraindications to live attenuated influenza vaccine and the provider administers the vaccine intranasally during a scheduled well-child visit. The clinical workflow includes verification of identity and vaccine history, screening for contraindications/allergies, informed consent from the parent, preparation of the intranasal dose, administration of the live attenuated vaccine to each nostril, documentation of lot number/expiration/manufacturer in the medical record and immunization registry, and observation for a brief post-vaccination period for adverse reactions. This procedure may also occur during community vaccination clinics at an ambulatory clinic or public health site when intranasal live attenuated vaccines are offered.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | When a same-day E/M visit meets criteria in addition to the vaccine administration (e.g., acute visit with evaluation beyond routine vaccine counseling). |
59 | Distinct procedural service | When another distinct procedure is performed unrelated to the vaccine administration during the same encounter. |
52 | Reduced services | When the vaccine administration is partially reduced or not completed as originally planned. |
53 | Discontinued procedure | When vaccine administration was started but discontinued due to patient reaction or other immediate contraindication. |
76 | Data not available in the input. | Data not available in the input. |
77 | Data not available in the input. | Data not available in the input. |
QK | Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals | Rarely applicable; included among available modifiers for completeness and not commonly used with vaccine administration. |
QX | CRNA service: CRNA with medical direction by a physician | Not typically applicable to intranasal vaccine administration. |
QY | Medical direction of one CRNA by an anesthesiologist | Not typically applicable to intranasal vaccine administration. |
GA | Waiver of liability statement on file (individual) | When a documented Advance Beneficiary Notice or waiver is on file for coverage issues. |
JZ | No patient relation to the service (no-op) | When patient declines an item or service that would otherwise be billed; rarely used for vaccine administration documentation. |
59 | Distinct procedural service | Duplicate entry removed in other contexts; included above once. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
208000000X | Pediatrics | Pediatricians commonly administer intranasal live attenuated vaccines during well visits. |
207Q00000X | Family Medicine | Family physicians provide routine immunizations for children and adults in ambulatory settings. |
363LP0800X | Public Health (Vaccine Clinics) | Public health nurses and clinic staff involved in mass vaccination events or public immunization programs. |
207K00000X | Internal Medicine | Internists may administer vaccines to adult patients when indicated. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
| Data not available in the input. | Data not available in the input. | Data not available in the input. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
90460 | Immunization administration through 18 years of age via intranasal or oral route; first vaccine/toxoid component | May be billed when multiple vaccine components or vaccine/toxoid administration rules apply and separate reporting is required for age-based administration. |
90461 | Immunization administration through 18 years of age via intranasal or oral route; each additional vaccine/toxoid component | Used when more than one vaccine component is administered in the same visit after the first component coded with 90460. |
90471 | Immunization administration (single or first) by intramuscular, intradermal, or subcutaneous injection | Related as an alternative route for vaccines when intranasal route is not used; not used simultaneously with intranasal administration. |
90472 | Each additional intramuscular, intradermal, or subcutaneous vaccine | Used for multiple injectable vaccines in the same encounter. |
90474 | Immunization administration by intranasal or oral route, single or first component, adult | Used for adult intranasal/oral vaccine administration when age-specific codes apply. |