90472 Immunization admin each add
What 90472 is
CMS fee schedule short descriptor: Immunization admin each add.
Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.
Medicare payment for 90472 (CY2026)
| Work RVU | Practice expense RVU | Malpractice RVU | Total | Medicare rate | |
|---|---|---|---|---|---|
| Non-facility (office) | 0.15 | 0.32 | 0.01 | 0.48 | $16.03 |
| Facility (hospital, ASC) | 0.15 | 0.32 | 0.01 | 0.48 | $16.03 |
National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.
Status: Active - payable under the Physician Fee Schedule. Global period: Add-on code: global period of the primary procedure applies.
Medically Unlikely Edit (MUE)
Medicare caps 90472 at 8 units per date of service for practitioner claims (MAI 3 - date of service edit (clinical): units above the MUE may pay with documentation on appeal), rationale: Clinical: Society Comment. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.
Billed with 90472? These codes are bundled into it
90472 is a Column 1 code in 57 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.
| Column 2 code | Short description | Modifier indicator | |
|---|---|---|---|
0591T | Hlth&wb coaching indiv 1st | 1 - modifier may bypass | Check pair |
0592T | Hlth&wb coaching indiv f-up | 1 - modifier may bypass | Check pair |
0593T | Hlth&wb coaching group | 1 - modifier may bypass | Check pair |
36591 | Draw blood off venous device | 0 - no modifier bypass | Check pair |
36592 | Collect blood from picc | 0 - no modifier bypass | Check pair |
96160 | Pt-focused hlth risk assmt | 1 - modifier may bypass | Check pair |
96161 | Caregiver health risk assmt | 1 - modifier may bypass | Check pair |
96523 | Irrig drug delivery device | 0 - no modifier bypass | Check pair |
99202 | Office o/p new sf 15 min | 1 - modifier may bypass | Check pair |
99203 | Office o/p new low 30 min | 1 - modifier may bypass | Check pair |
99204 | Office o/p new mod 45 min | 1 - modifier may bypass | Check pair |
99205 | Office o/p new hi 60 min | 1 - modifier may bypass | Check pair |
99211 | Off/op est may x req phy/qhp | 1 - modifier may bypass | Check pair |
99212 | Office o/p est sf 10 min | 1 - modifier may bypass | Check pair |
99213 | Office o/p est low 20 min | 1 - modifier may bypass | Check pair |
99214 | Office o/p est mod 30 min | 1 - modifier may bypass | Check pair |
99215 | Office o/p est hi 40 min | 1 - modifier may bypass | Check pair |
99242 | Off/op consltj new/est sf 20 | 1 - modifier may bypass | Check pair |
99243 | Off/op cnsltj new/est low 30 | 1 - modifier may bypass | Check pair |
99244 | Off/op cnsltj new/est mod 40 | 1 - modifier may bypass | Check pair |
99245 | Off/op consltj new/est hi 55 | 1 - modifier may bypass | Check pair |
99281 | Emr dpt vst mayx req phy/qhp | 1 - modifier may bypass | Check pair |
99282 | Emergency dept visit sf mdm | 1 - modifier may bypass | Check pair |
99283 | Emergency dept visit low mdm | 1 - modifier may bypass | Check pair |
99284 | Emergency dept visit mod mdm | 1 - modifier may bypass | Check pair |
99285 | Emergency dept visit hi mdm | 1 - modifier may bypass | Check pair |
99381 | Init pm e/m new pat infant | 1 - modifier may bypass | Check pair |
99382 | Init pm e/m new pat 1-4 yrs | 1 - modifier may bypass | Check pair |
99383 | Prev visit new age 5-11 | 1 - modifier may bypass | Check pair |
99384 | Prev visit new age 12-17 | 1 - modifier may bypass | Check pair |
Showing 30 of 57 column 2 codes. Use the pair checker for any specific combination.
Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.