CPT 90472
Global ZZZ ActiveImmunization admin each add
CPT 90472 Billing & Documentation Guide
CPT code 90472 (Immunization admin each add) is classified under Vaccines/Immunization with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.15, a non-facility practice expense RVU of 0.32, and a malpractice RVU of 0.01, a total non-facility RVU of 0.48 and facility RVU of 0.48. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $16.55, though rates vary from $14.36 to $21.15 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 90472, 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 90472 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 90472 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 90472
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.15 | 0.15 |
| Practice Expense RVU | 0.32 | 0.32 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 0.48 | 0.48 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 90472
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 | $18.02 | $18.02 | $16.99 - $21.15 | 29 |
| Florida | $16.38 | $16.38 | $15.73 - $16.98 | 3 |
| Georgia | $15.61 | $15.61 | $14.94 - $16.29 | 2 |
| Illinois | $15.99 | $15.99 | $15.29 - $16.61 | 4 |
| Michigan | $15.52 | $15.52 | $15.15 - $15.89 | 2 |
| North Carolina | $15.2 | $15.2 | $15.2 - $15.2 | 1 |
| New York | $17.63 | $17.63 | $15.4 - $18.66 | 5 |
| Ohio | $15.11 | $15.11 | $15.11 - $15.11 | 1 |
| Pennsylvania | $15.89 | $15.89 | $15.14 - $16.63 | 2 |
| Texas | $15.87 | $15.87 | $15.05 - $16.62 | 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 90472
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 90472 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 90472
What does CPT code 90472 mean? +
CPT code 90472 represents: Immunization admin each add. It's in the Vaccines/Immunization category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 90472? +
The 2026 Medicare national average non-facility payment for CPT 90472 is $16.55. Rates range from $14.36 to $21.15 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 90472? +
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 90472? +
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