CPT 90474: Additional Live Attenuated Vaccine, Oral or Intranasal
CPT code 90474 represents the administration of an additional live attenuated vaccine given orally or intranasally after the initial vaccine dose during the same encounter. This code is used to document sequential delivery of a second live attenuated immunization and matters nationally because accurate coding affects vaccination records, quality reporting, and appropriate claims processing for outpatient immunization services.
Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of where and how this service is typically delivered, payer coverage context, and the implications for billing and documentation. The publication outlines benchmarks and coding guidance, highlights common billing modifiers used with immunization services, and summarizes clinical context for live attenuated oral or intranasal vaccines.
The report is intended for health plan analysts, provider billing teams, and policy stakeholders seeking a national perspective on coding practice for additional live attenuated vaccine administration. It provides clear definitions, common payer considerations, and points for operational attention to support accurate claims submission and immunization recordkeeping.
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Billing Code Overview
CPT code 90474 describes administration of an additional live attenuated vaccine given by the provider via an oral or intranasal route after the first vaccine has been administered. The service reflects sequential delivery of a live attenuated immunization when multiple live attenuated doses are provided during the same patient encounter.
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Service type: Vaccine administration, additional live attenuated vaccine dose
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Typical site of service: Ambulatory clinic, physician office, or other outpatient setting where vaccines are administered
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Clinical & Coding Specifications
Clinical Context
A pediatric clinic administers a live attenuated influenza vaccine (LAIV) intranasally to a 4-year-old child during the annual influenza season. The nurse documents consent, screens for contraindications (e.g., severe egg allergy, immunocompromise, recent antiviral use), and administers the first dose of LAIV. The patient has a second, clinically indicated dose during the same encounter (for example, a catch-up dose or an additional LAIV formulation), and the provider administers the additional live attenuated vaccine via the oral or intranasal route as a separate administration billed with 90474. The clinical workflow includes verification of vaccine lot and expiration, counseling to the parent, vaccine administration, observation for immediate adverse reaction, and documentation of vaccine type, route, dose, and lot number in the medical record and immunization registry. Typical sites of service are outpatient clinics, pediatrician offices, public health clinics, and school-based health centers.
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 or other service | Use when a distinct E/M visit is provided on the same day as 90474 and meets documentation for a separate E/M service |
59 | Distinct procedural service | Use when 90474 represents a separate, distinct administration that is not bundled with another vaccine administration code |
76 | Repeat procedure or service by same physician or other qualified health care professional | Use when 90474 is a repeat administration during the same encounter by the same provider |
77 | Repeat procedure by another physician or other qualified health care professional | Use when a different provider performs the repeated administration of 90474 during the same encounter |
52 | Reduced services | Use if the vaccine administration is partially performed or abbreviated relative to full procedure requirements |
53 | Discontinued procedure | Use when the vaccine administration procedure was started but discontinued due to patient reaction or refusal |
25 | Significant, separately identifiable E/M service (listed above) | Duplicate entry omitted in use; ensure not duplicated in billing |
59 | Distinct procedural service (listed above) | Duplicate entry omitted in use; ensure not duplicated in billing |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery (not typically applicable) | Rarely applicable; used only if payer requires designation of advanced practitioner involvement per policy |
QK | Medical direction of two, three, or four concurrent anesthesia procedures (not applicable) | Not typically relevant for vaccine administration but included in payer lists; avoid use unless specifically required by payer policy |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Pediatrics | Pediatricians commonly administer 90474 for childhood immunizations |
| 208000000X | Family Medicine | Family physicians provide routine immunizations including LAIV administrations |
| 174400000X | Public Health/General Preventive Medicine | Public health clinicians and immunization clinics administer vaccines in population health settings |
| 163W00000X | Registered Nurse | Registered nurses frequently perform vaccine administration in clinic and school-based settings |
| 367400000X | Nurse Practitioner | Nurse practitioners independently administer vaccines and document 90474 when applicable |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z23 | Encounter for immunization | Common encounter diagnosis when administering any vaccine, including 90474 |
J09.X2 | Influenza due to identified novel influenza A virus with other respiratory manifestations | Relevant when documenting influenza vaccination context during outbreak management or specific strain concerns |
J10.1 | Influenza due to other identified influenza virus with other respiratory manifestations | May be used in clinical context linking vaccination efforts to circulating influenza strains |
Z00.129 | Encounter for routine child health examination without abnormal findings | Used when vaccines are given during routine well-child visits |
Z71.89 | Other specified counseling | Used when vaccine counseling is a documented component of the visit |
Z28.3 | Underimmunization status | Relevant for catch-up immunizations where additional vaccine administrations like 90474 are provided |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
90460 | 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/toxoid administered | Often billed when an initial vaccine is administered to a patient younger than 19 with counseling; 90474 would represent an additional live attenuated vaccine given after the first |
90461 | Immunization administration through 18 years of age via any route of administration, with counseling; each additional vaccine/toxoid (List separately in addition to code for primary procedure) | Used to report additional vaccine administrations in pediatric patients when multiple vaccines are given; clinically related to 90474 when multiple doses are administered |
90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid) | May be used for injectable vaccines given in the same encounter when LAIV is given concurrently or sequentially |
90472 | Immunization administration; each additional vaccine (single or combination vaccine/toxoid) | Used when multiple injectable vaccines are administered in the visit in addition to the first |
90473 | Immunization administration by intranasal or oral route; one vaccine | Used for the first oral or intranasal vaccine administration; 90474 specifically reports the additional live attenuated vaccine administered after the first |
90475 | Immunization administration by intranasal or oral route; each additional vaccine | Used to report further additional oral/intranasal vaccines beyond the second; complements 90474 in multi-dose oral/intranasal scenarios |