CPT code 90472: Vaccine administration, each additional vaccine2026 Medicare rate & RVUs in Texas
Reports administration of each additional intramuscular or subcutaneous vaccine after the first vaccine in an encounter, when the add-on requirements are met.
Medicare pays $15.05–$16.62 for 90472 in the office in Texas, from Beaumont, TX to Austin, TX. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 90472 covers
90472 represents administration of each additional vaccine after the first intramuscular or subcutaneous vaccine during an encounter. It covers the administration work, not the vaccine product; report the product separately when applicable. Nurses and other clinical staff commonly perform the service in an office or clinic. For pediatric visits, the standard administration codes may be appropriate when the face-to-face physician or qualified health professional counseling circumstance for 90460 and 90461 is not present.
Report 90471 for the first vaccine and 90472 for each additional vaccine administered by the intramuscular or subcutaneous route. Do not count the components of a combination vaccine as separate administrations. Documentation should identify the vaccine products, routes, and which administration was first versus additional. As an add-on, 90472 must be reported with a primary procedure and CMS payment is within that procedure’s global period. Under the CMS incident-to rule, report it only when performed under physician supervision.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 90472 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$15.05 to $16.62
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $16.62 | Unavailable |
| Beaumont, TX | $15.05 | Unavailable |
| Brazoria, TX | $15.90 | Unavailable |
| Dallas, TX | $15.99 | Unavailable |
| Fort Worth, TX | $15.88 | Unavailable |
| Galveston, TX | $15.94 | Unavailable |
| Houston, TX | $16.12 | Unavailable |
| Rest of Texas | $15.45 | Unavailable |
How the 90472 rate is calculated
Each of 90472’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 90472
RVUs × geographic indexes × conversion factor
Work0.15
0.15 RVUs× 1.000 GPCI
Practice expense0.32
0.32 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
0.4800
Conversion factor
$33.4009
Medicare rate
$16.03
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 90472
The CMS indicators that decide how 90472 is paid alongside other services.
CMS payment indicators · 90472
Vaccine administration, each additional vaccine
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 5 | Incident-to service. |
90472 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 90471Immunization administrationFirst injectable vaccine
- 90471 reports the first intramuscular or subcutaneous vaccine in the encounter; 90472 reports each additional vaccine and requires a primary procedure.
- 90474Vaccine administrationAdditional oral or nasal vaccine
- 90474 is for each additional vaccine given orally or intranasally. Use 90472 for additional intramuscular or subcutaneous vaccine administrations.
- 90461Vaccine administrationEach additional component
- 90461 reports additional vaccine components in the qualifying pediatric counseling-based administration sequence. 90472 counts additional vaccines in the standard intramuscular or subcutaneous sequence.
90472 billing questions
Which code reports the first intramuscular or subcutaneous vaccine?
Use 90471 for the first vaccine and 90472 for each additional vaccine administered by either route.
Can 90472 be reported without 90471?
No. It is an add-on code and must be reported with a qualifying primary procedure; for this administration sequence, report 90471 for the first vaccine.
Is the vaccine product included in 90472?
No. 90472 represents administration. Report the vaccine product separately when applicable.
How should a combination vaccine be counted?
Count the combination vaccine as one administered vaccine, not as separate administrations for each component.
What documentation supports reporting 90472?
Document the vaccine administered, its route, and that it was an additional vaccine after the first. CMS requires physician supervision for incident-to billing.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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