Summary & Overview
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.
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 |