Summary & Overview

HCPCS Level II M1472: Incomplete Hepatitis B Vaccination by Age

HCPCS Level II code M1472 documents that a patient has not received the recommended doses of hepatitis B vaccine for their age. Nationally, accurate capture of missed or incomplete immunizations is critical for population health monitoring, preventive care quality measures, and immunization program management. Use of M1472 supports clear communication among providers, payers, and public health entities about immunization status without implying vaccine refusal.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical meaning, the typical service context where it is used, and what to expect from payer coverage patterns. The publication outlines benchmarks for documentation and coding frequency where available, recent policy updates affecting immunization reporting, and clinical context on age-based hepatitis B vaccine schedules to frame use of the code.

This summary is intended for a national audience of clinicians, coders, and policy analysts seeking clarity on how M1472 functions within immunization reporting and preventive care workflows. Data not available in the input will be noted where relevant in the full publication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1472HCPCS Level IIhepatitis Bimmunizationvaccinationpreventive careambulatory carecoding

Billing Code Overview

HCPCS Level II code M1472 indicates that the patient did not receive recommended doses of hepatitis B vaccination based on age. This code denotes incomplete or missed hepatitis B vaccine doses relative to age-based schedules.

Service Type: Vaccination assessment and immunization record review.

Typical Site of Service: Outpatient clinics, primary care offices, public health clinics, and other ambulatory care settings where vaccinations and immunization counseling occur.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult or adolescent who presents to a primary care clinic, community health center, or public health vaccination clinic and is identified as having incomplete or missing hepatitis B vaccine doses for their age and immunization history. During intake, the nurse or medical assistant reviews the immunization record and immunization registry, confirms prior hepatitis B vaccine doses and dates, and documents that the patient has not received the recommended number of hepatitis B vaccine doses. The clinician (physician, nurse practitioner, or physician assistant) reviews contraindications, obtains informed consent, and documents the medical necessity for catch-up vaccination. The clinical workflow includes verifying serologic immunity if indicated, administering the appropriate hepatitis B vaccine dose when available, scheduling the remaining doses in the series, and recording lot number, route, site, and vaccine VIS (Vaccine Information Statement) given. If the patient declines or the vaccine is unavailable, the encounter is coded to indicate the patient did not receive recommended hepatitis B vaccination based on age using billing code M1472. Typical sites of service include primary care offices, community health centers, federally qualified health centers (FQHCs), public health clinics, and outpatient ambulatory clinics. Common patient scenarios include: individuals who moved between jurisdictions with incomplete records, adults who missed childhood vaccination series, pregnant patients without documented immunity assessed and deferred, or patients with access barriers who have incomplete series and present for care but do not receive the vaccine during that visit.

Coding Specifications

Modifier	Description	When to Use

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians who commonly assess immunization status and administer or document vaccination refusal or deferral
`208D00000X`	General Internal Medicine	Adult primary care providers routinely manage catch-up immunizations and document vaccine refusal or missed doses
`363L00000X`	Public Health & General Preventive Medicine	Clinicians in public health clinics and community vaccination programs managing population immunization records
`367500000X`	Nurse Practitioner	NPs who provide vaccination counseling, administration, and documentation in ambulatory settings
`363A00000X`	Physician Assistant	PAs in outpatient clinics who evaluate immunization status and perform vaccine administration or documentation

ICD-10 Code	Description	Clinical Relevance
`Z28.2`	Immunization not carried out because of patient decision for reasons of belief and personal preference	Relevant when a patient declines hepatitis B vaccination despite recommendation
`Z28.20`	Immunization not carried out because of patient decision, unspecified	Use when documentation indicates patient decision prevented receiving hepatitis B vaccine but specifics are not provided
`Z28.3`	Underimmunization status	Applicable to patients who have not completed recommended hepatitis B vaccine series for age
`Z23`	Encounter for immunization	Used when immunization is addressed during the visit; appropriate when documenting that hepatitis B vaccine was considered but not administered
`Z11.59`	Encounter for screening for other viral diseases	May apply when serologic testing for hepatitis B immunity is performed or considered prior to vaccination decision
`O98.431`	Viral hepatitis B complicating pregnancy, third trimester	Relevant in prenatal settings where hepatitis B vaccination status is reviewed and vaccination may be deferred or managed differently
`Z71.89`	Other specified counseling	Used when specific immunization counseling about hepatitis B is documented but vaccine is not administered

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90460`	Immunization administration through 18 years of age via any route, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered	Performed when an eligible pediatric patient actually receives a hepatitis B vaccine dose; relates as the administration code used when vaccine is given rather than documented as not received
`90471`	Immunization administration (single vaccine) percutaneous, intradermal, subcutaneous, or intramuscular	Used for single vaccine administration in patients when the hepatitis B vaccine is given during the visit
`90472`	Each additional vaccine administered (List separately in addition to code for primary procedure)	Used when hepatitis B vaccine is given in combination with additional vaccines during the same visit
`99381`	Initial comprehensive preventive medicine evaluation and management of an individual including age and gender appropriate history and immunization review (new patient, infant to 11 months)	Preventive visit codes often include vaccine review and may precede decisions to vaccinate; documents assessment when vaccine not given
`99391`	Periodic comprehensive preventive medicine reevaluation and management of an individual including age and gender appropriate history and immunization review (established patient, infant to 11 months)	Used for periodic wellness visits where immunization status is reviewed and hepatitis B vaccine may be deferred or not administered
`G0008`	Administration of influenza vaccine, including counseling to beneficiaries 65 years and older (Medicare)	Included as an example of vaccine-specific administration codes used by payers; relates conceptually to vaccine administration workflows though not specific to hepatitis B

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