How To Use CPT Code 90474

CPT 90474 describes the administration of an additional live attenuated vaccine via oral or intranasal route after the initial vaccine has been administered. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 90474?

CPT 90474 can be used to describe the administration of an additional live attenuated vaccine either orally or through the intranasal route. This code is used when the provider administers an extra mix of a single vaccine or multiple vaccines or toxoids during immunization after the initial vaccine has been given.

2. Official Description

The official description of CPT code 90474 is: ‘Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure).’ This code should be used in conjunction with the appropriate primary administration code (90473, 90460, 90471, 90473) and should not be reported with codes 91300-91317, unless a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine/toxoid product and at least one vaccine/toxoid product from 90476-90759 are administered at the same encounter.

3. Procedure

1. After administering the initial vaccine, the provider prepares the patient for an additional live attenuated vaccine during the same session.

4. Qualifying circumstances

Patients eligible to receive CPT 90474 services are those who have already received an initial vaccine and require an additional live attenuated vaccine for immunization. The provider administers the additional vaccine orally or through the intranasal route. The patient may need multiple vaccines or toxoids, and the provider ensures that the patient meets the necessary criteria for immunization.

5. When to use CPT code 90474

CPT code 90474 should be used when the provider administers an additional live attenuated vaccine via oral or intranasal route after the initial vaccine has been given. This code should not be reported without the appropriate primary administration code (90473, 90460, 90471, 90473). It should also not be reported with codes 91300-91317, unless specific criteria are met.

6. Documentation requirements

To support a claim for CPT 90474, the provider must document the following information:

• Administration of the initial vaccine
• Administration of the additional live attenuated vaccine via oral or intranasal route
• Date and time of the administration
• Specific vaccines or toxoids administered
• Signature of the provider

7. Billing guidelines

When billing for CPT 90474, ensure that the appropriate primary administration code (90473, 90460, 90471, 90473) is also reported. Do not report CPT 90474 without the primary administration code. Additionally, be aware of the specific circumstances in which CPT 90474 should or should not be reported with other codes. It is important to follow the guidelines provided by payers to ensure proper reimbursement.

8. Historical information

CPT 90474 was added to the Current Procedural Terminology system on January 1, 2002. There have been no updates to the code since its addition.

9. Examples

1. A pediatrician administers the initial measles vaccine to a child and then administers an additional live attenuated vaccine orally during the same visit.
2. A nurse administers the initial influenza vaccine to an adult and then administers an additional live attenuated vaccine via intranasal route during the same appointment.
3. A family physician administers the initial varicella vaccine to a teenager and then administers an additional mix of multiple vaccines orally during the same session.
4. A healthcare provider administers the initial pneumococcal vaccine to an elderly patient and then administers an additional live attenuated vaccine via intranasal route during the same encounter.
5. A nurse practitioner administers the initial rotavirus vaccine to an infant and then administers an additional live attenuated vaccine orally during the same visit.
6. A pharmacist administers the initial hepatitis A vaccine to an adult and then administers an additional live attenuated vaccine via intranasal route during the same appointment.
7. A healthcare provider administers the initial typhoid vaccine to a traveler and then administers an additional mix of multiple vaccines orally during the same session.
8. A nurse administers the initial polio vaccine to a child and then administers an additional live attenuated vaccine via intranasal route during the same encounter.
9. A physician administers the initial yellow fever vaccine to a traveler and then administers an additional live attenuated vaccine orally during the same visit.
10. A healthcare provider administers the initial mumps vaccine to an adult and then administers an additional live attenuated vaccine via intranasal route during the same appointment.