How To Use CPT Code 90472

CPT 90472 refers to the administration of each additional vaccine after the first one, and this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 90472?

CPT 90472 is a medical billing code used to represent the administration of each additional vaccine (single or combination vaccine/toxoid) after the first one. This code is applicable for various routes of administration, including percutaneous, intradermal, subcutaneous, or intramuscular injections. It is essential for medical professionals to understand the proper usage and documentation of this code to ensure accurate billing and reimbursement.

2. 90472 CPT code description

The official description of CPT code 90472 is: “Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)”.

3. Procedure

The 90472 procedure involves the following steps:

1. Identify the patient and verify their medical history and vaccine requirements.
2. Prepare the vaccine(s) according to the manufacturer’s instructions.
3. Select the appropriate route of administration (percutaneous, intradermal, subcutaneous, or intramuscular).
4. Administer the additional vaccine(s) after the first one, following proper injection techniques and guidelines.
5. Document the vaccine administration, including the vaccine type, dosage, route, and site of injection.
6. Monitor the patient for any adverse reactions or side effects.

4. Qualifying circumstances

Patients eligible to receive CPT code 90472 services are those who require multiple vaccines during a single encounter. This may include individuals with specific medical conditions, those traveling to areas with high-risk infectious diseases, or individuals requiring routine immunizations as part of their preventive healthcare. Healthcare providers must ensure that the additional vaccines administered are medically necessary and follow the recommended immunization schedules and guidelines.

5. When to use CPT code 90472

It is appropriate to bill the 90472 CPT code when a patient receives more than one vaccine during a single encounter, and the additional vaccine(s) are administered through percutaneous, intradermal, subcutaneous, or intramuscular routes. This code should be listed separately in addition to the code for the primary procedure (first vaccine administration).

6. Documentation requirements

To support a claim for CPT 90472, the following information must be documented in the patient’s medical record:

• Patient’s demographic information and medical history.
• Indication for the additional vaccine(s).
• Type of vaccine(s) administered, including the brand name and manufacturer.
• Dosage and route of administration.
• Site of injection.
• Date and time of administration.
• Name and title of the person administering the vaccine(s).
• Any observed adverse reactions or side effects.

7. Billing guidelines

When billing for CPT code 90472, it is essential to follow specific guidelines and rules to ensure accurate reimbursement. Some of these guidelines include:

• Listing CPT 90472 separately in addition to the code for the primary procedure (first vaccine administration).
• Using CPT 90472 in conjunction with codes 90460, 90471, and 90473.
• Not reporting CPT 90471 and 90472 in conjunction with codes 91300-91317 if both a COVID-19 vaccine and at least one vaccine from 90476-90759 are administered during the same encounter.
• For immune globulins, refer to codes 90281-90399, and for administration of immune globulins, refer to codes 96365-96374.
• For intravesical administration of BCG vaccine, refer to codes 51720 and 90586.

8. Historical information

CPT 90472 was added to the Current Procedural Terminology system on January 1, 1999. There have been several updates to the code since its introduction, with the most recent change occurring on January 1, 2005.

9. Similar codes to CPT 90472

Five similar codes to CPT 90472 and how they differentiate are:

• CPT 90460: This code represents the administration of the first vaccine to a patient under 18 years of age, including counseling by a physician or other qualified healthcare professional.
• CPT 90471: This code is used for the administration of the first vaccine to a patient, regardless of age, without physician counseling.
• CPT 90473: This code is used for the administration of each additional oral or intranasal vaccine after the first one.
• CPT 96372: This code represents the administration of a therapeutic, prophylactic, or diagnostic injection, not related to vaccines.
• CPT 96374: This code is used for the administration of an intravenous infusion for therapy, prophylaxis, or diagnosis, not related to vaccines.

10. Examples

Here are 10 detailed examples of CPT code 90472 procedures:

1. A patient receives a flu vaccine and a pneumonia vaccine during the same visit. CPT 90472 would be billed for the administration of the pneumonia vaccine.
2. A child receives the MMR, DTaP, and IPV vaccines during a routine immunization visit. CPT 90472 would be billed for the administration of the DTaP and IPV vaccines.
3. An adult receives a tetanus booster and a hepatitis B vaccine during a single encounter. CPT 90472 would be billed for the administration of the hepatitis B vaccine.
4. A patient traveling to a high-risk area receives a typhoid vaccine and a yellow fever vaccine. CPT 90472 would be billed for the administration of the yellow fever vaccine.
5. A healthcare worker receives an annual flu vaccine and a hepatitis B booster. CPT 90472 would be billed for the administration of the hepatitis B booster.
6. A pregnant woman receives a Tdap vaccine and an influenza vaccine during the same visit. CPT 90472 would be billed for the administration of the influenza vaccine.
7. An elderly patient receives a shingles vaccine and a pneumococcal vaccine during a single encounter. CPT 90472 would be billed for the administration of the pneumococcal vaccine.
8. A patient with a chronic medical condition receives a meningococcal vaccine and a hepatitis A vaccine. CPT 90472 would be billed for the administration of the hepatitis A vaccine.
9. A college student receives an HPV vaccine and a meningococcal vaccine during a single visit. CPT 90472 would be billed for the administration of the meningococcal vaccine.
10. An individual receives a rabies vaccine and a Japanese encephalitis vaccine for travel purposes. CPT 90472 would be billed for the administration of the Japanese encephalitis vaccine.