CPT 90461
Global ZZZ ActiveIm admin each addl component
CPT 90461 Billing & Documentation Guide
CPT code 90461 (Im admin each addl component) is classified under Vaccines/Immunization with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.18, a non-facility practice expense RVU of 0.07, and a malpractice RVU of 0.01, a total non-facility RVU of 0.26 and facility RVU of 0.26. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $8.86, though rates vary from $8.19 to $11.69 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 90461, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 90461 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Add-on code (global concept does not apply)
MUE Limit (Medically Unlikely Edits)
Submitting more than 8 units of 90461 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 90461
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.18 | 0.18 |
| Practice Expense RVU | 0.07 | 0.07 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 0.26 | 0.26 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 90461
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $9.18 | $9.18 | $8.86 - $10.22 | 29 |
| Florida | $9.01 | $9.01 | $8.75 - $9.29 | 3 |
| Georgia | $8.66 | $8.66 | $8.5 - $8.81 | 2 |
| Illinois | $8.93 | $8.93 | $8.67 - $9.17 | 4 |
| Michigan | $8.68 | $8.68 | $8.52 - $8.83 | 2 |
| North Carolina | $8.41 | $8.41 | $8.41 - $8.41 | 1 |
| New York | $9.36 | $9.36 | $8.47 - $9.8 | 5 |
| Ohio | $8.48 | $8.48 | $8.48 - $8.48 | 1 |
| Pennsylvania | $8.71 | $8.71 | $8.47 - $8.95 | 2 |
| Texas | $8.66 | $8.66 | $8.45 - $8.84 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 90461
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 90461 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0591T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0592T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0593T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 96160 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 96160 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 96161 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 96161 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 90461
What does CPT code 90461 mean? +
CPT code 90461 represents: Im admin each addl component. It's in the Vaccines/Immunization category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 90461? +
The 2026 Medicare national average non-facility payment for CPT 90461 is $8.86. Rates range from $8.19 to $11.69 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 90461? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 90461? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team