CPT 90476: Adenovirus Type 4 Oral Vaccine Administration - OpenPayer

Summary & Overview

CPT 90476: Adenovirus Type 4 Oral Vaccine Administration

CPT code 90476 denotes administration of a live oral vaccine for adenovirus type 4, used to prevent respiratory illness caused by this viral serotype. Nationwide, this code is relevant for immunization programs in outpatient and public health settings where oral vaccine delivery is indicated. The code captures the service of preparing and administering the live attenuated adenovirus type 4 vaccine by mouth.

Key payers in this review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical role of the adenovirus type 4 oral vaccine, common billing considerations tied to vaccine administration services, and how major payers approach coverage and coding for immunization encounters. The summary highlights expected sites of service and the types of clinical programs that commonly use the vaccine, such as primary care, travel medicine, and public health immunization efforts.

This publication is organized to deliver benchmarks where available, note relevant payer policies and coverage themes, and provide clinical context for billing staff and policy teams responsible for coding, reporting, and reimbursing oral live vaccine administration services associated with CPT code 90476. Data not available in the input will be identified as such in detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 90476vaccine administrationadenovirus type 4oral vaccineimmunization billingoutpatient servicespublic health immunizationvaccine coding

Billing Code Overview

CPT code 90476 represents administration of a live oral vaccine product to protect against adenovirus type 4, a cause of respiratory illness and other related conditions. The service involves vaccine preparation and oral delivery of a live attenuated adenovirus type 4 vaccine.

Service Type: Vaccine administration (oral)

Typical Site of Service: Outpatient clinics, primary care offices, travel medicine clinics, and military or public health immunization programs

Clinical & Coding Specifications

Clinical Context

A 19-year-old military recruit presents to the immunization clinic for entry medical processing. Per military immunization requirements and outbreak prevention protocols, the patient requires administration of an oral live adenovirus type 4 vaccine to reduce risk of acute respiratory illness during close-quarter training. The clinical workflow includes identity verification, review of immunization history and contraindications (including immunocompromise and pregnancy), informed consent, confirmation of vaccine lot and expiration, preparation of the oral vaccine, direct observation of administration, documentation of vaccine manufacturer, lot number, route, site (oral), date, and administering provider, and post-vaccination observation for immediate adverse reactions. Billing is submitted using 90476 for the oral live adenovirus type 4 vaccine administration, with appropriate modifier(s) appended if specific circumstances apply (for example, those indicating professional/service circumstances, costs, or anesthesia are relevant). Typical sites of service are outpatient immunization clinics, primary care offices, occupational health clinics, and military medical treatment facilities.

Coding Specifications

Modifier	Description	When to Use
`00`	Default/No modifier specified by local payer	Use when no other modifier applies and payer requires explicit for neutral reporting.

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Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians who commonly provide routine immunizations.
`208D00000X`	Pediatrics	Pediatricians providing immunizations to adolescents and young adults.
`335Y00000X`	Preventive Medicine	Specialists focused on immunization programs, occupational and public health clinics.
`366A00000X`	Public Health (Local/State)	Providers administering vaccines in public health and military vaccination programs.
`334P00000X`	Occupational Medicine	Clinicians providing immunizations for workforce/military readiness.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z23`	Encounter for immunization	Most common diagnosis code to accompany vaccine administration claims; documents the encounter reason for receipt of `90476`.
`Z29.2`	Isolation of other immunizations	Used in some reporting situations to indicate prophylactic vaccination measures; may be applied in public health or military protocols.
`B97.89`	Other viral agents as the cause of diseases classified elsewhere	May be used in surveillance when adenovirus is implicated in clinical illness; not typically used for routine prophylactic administration.
`J10.1`	Influenza due to other identified influenza virus with other respiratory manifestations	Included here as an example of respiratory viral diagnoses encountered in same clinical settings; not a direct indication for adenovirus vaccination.
`R05`	Cough	Symptom code that may be documented to rule out active respiratory infection prior to vaccination; active moderate/severe illness can be a contraindication.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90460`	Immunization administration through 18 years of age via intramuscular or subcutaneous injection; with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered	May be used for counseling and administration when injectable vaccines are given during the same visit as the oral adenovirus vaccine for pediatric patients (age criteria apply).
`90471`	Immunization administration (single) intramuscular or subcutaneous; first vaccine/toxoid component	Often billed for single injectable vaccines administered during the same visit; used when a single injectable vaccine accompanies the oral `90476` administration.
`90715`	Tetanus, diphtheria, acellular pertussis (Tdap) vaccine, intramuscular	Common concurrent adult immunization; may be administered and documented in the same encounter as `90476` and billed separately using the vaccine product code.
`90732`	Hepatitis A vaccine, adult dosage, intramuscular, for pre-exposure prophylaxis	Example of another vaccine that may be co-administered in occupational or travel settings; billed as separate vaccine product and administration codes.
`90476`	Live vaccine, oral, adenovirus type 4, includes administration (per code context)	Primary code used to report the oral adenovirus type 4 vaccine administration.
`90474`	Immunization administration by oral or intranasal route; each additional vaccine (when multiple oral/nasal vaccines are given)	Use when more than one oral or intranasal vaccine is administered during the same encounter along with `90476`.

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