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    v1.0.30
    OpenPayerBilling CodesImmunization Administration for Vaccines/ToxoidsCPT cpt-90474-additional-live-attenuated-vaccine-oral-intranasal-administration
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    CPT 90474: Additional Live Attenuated Vaccine, Oral or Intranasal

    Medicare pays $13 on average nationally for this procedure.

    CPT code 90474 describes administration of an additional live attenuated vaccine given by oral or intranasal route immediately following the first vaccine; this is an additional vaccine administration service typically performed as an immunization administration in outpatient clinic, physician office, public health clinic, or pharmacy immunization settings where live attenuated oral or intranasal vaccines are provided.

    For related coverage guidance, see recent payer policy updates: Abortion Services, Prolonged Services for Labor Management, Prolonged Services for Labor Management.

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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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    90460Immunization 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 administeredOften 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
    90461Immunization 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
    90471Immunization 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
    90472Immunization administration; each additional vaccine (single or combination vaccine/toxoid)Used when multiple injectable vaccines are administered in the visit in addition to the first
    90473Immunization administration by intranasal or oral route; one vaccineUsed for the first oral or intranasal vaccine administration; 90474 specifically reports the additional live attenuated vaccine administered after the first
    90475Immunization administration by intranasal or oral route; each additional vaccineUsed to report further additional oral/intranasal vaccines beyond the second; complements 90474 in multi-dose oral/intranasal scenarios

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207Q00000X
    208000000X
    174400000X
    163W00000X
    261QM1000X
    2083A0300X
    332BC3200X
    261QR0400X

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    A08.39Other viral enteritis
    A08.4Viral intestinal infection, unspecified
    B34.2Coronavirus infection, unspecified
    B34.9Viral infection, unspecified
    B35.0Tinea barbae and tinea capitis
    B97.89Other viral agents as the cause of diseases classified elsewhere
    J00Acute nasopharyngitis [common cold]
    J06.9Acute upper respiratory infection, unspecified
    J20.9Acute bronchitis, unspecified
    R50.2Drug induced fever

    Showing 1–10 of 28

    Related Payer Policy Updates

    Specialty: Obstetrics/Gynecology1 / 3

    10 rows

    PolicyPayerEffective Date
    Abortion ServicesNew Mexico Health Care Authority2027-01-01
    Prolonged Services for Labor ManagementPremera Bluecross2027-01-01
    Prolonged Services for Labor ManagementPremera Bluecross2027-01-01
    Maternal Serum Testing for Prediction of Adverse Obstetric OutcomesPremera Bluecross2026-10-01
    Maternal Serum Testing for Prediction of Adverse Obstetric OutcomesPremera Bluecross2026-10-01
    Maternal Serum Testing for Prediction of Adverse Obstetric OutcomesBlue Cross Blue Shield - Massachusetts2026-10-01
    Cervical Cancer ScreeningOscar Health2026-10-01
    Prenatal Testing for Fetal AneuploidyOscar Health2026-10-01
    Diagnosis of VaginitisOscar Health2026-10-01
    Prenatal Screening (Nongenetic)Oscar Health2026-10-01

    Related Codes

    CPT-90460-SINGLE-LIVE-ATTENUATED-VACCINE-ADMINISTRATION-PEDIATRIC

    CPT 90460: Administration of Single Live Attenuated Vaccine, ≤18 Years

    CPT-90461-ADDITIONAL-LIVE-ATTENUATED-VACCINE-ADMINISTRATION-PEDIATRICS

    CPT 90461: Additional Live Attenuated Vaccine Administration, Pediatrics

    CPT-90471-LIVE-ATTENUATED-VACCINE-ADMINISTRATION

    CPT 90471: Live Attenuated Vaccine Administration

    CPT-90472-ADDITIONAL-VACCINE-INJECTION

    CPT 90472: Vaccine Injection, Subsequent Dose

    CPT-90473-LIVE-ATTENUATED-INTRANASAL-OR-ORAL-VACCINE-ADMINISTRATION

    CPT 90473: Live Attenuated Intranasal or Oral Vaccine Administration

    CPT-90480-COVID19-VACCINE-IM-INJECTION-FIRST-DOSE

    CPT 90480: COVID-19 Vaccine, First or Only Intramuscular Dose

    CPT-90481-MULTICOMPONENT-COVID19-VACCINE-INTRAMUSCULAR-ADD-ON

    CPT 90481: Multicomponent SARS–CoV–2 Vaccine Administration, Intramuscular

    CPT-90482-IMMUNIZATION-COUNSELING-NO-VACCINE-ADMINISTERED

    CPT 90482: Immunization Counseling, 3–10 Minutes

    CPT-90483-IMMUNIZATION-COUNSELING-NO-ADMINISTRATION-10-20-MIN

    CPT 90483: Immunization Counseling, 10–20 Minutes

    CPT-90484-IMMUNIZATION-COUNSELING-NO-VACCINE-ADMINISTERED

    CPT 90484: Immunization Counseling >20 Minutes

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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