$21.66
90460 reports the first vaccine component for a patient age 18 or younger when the counseling requirements are met. 90461 reports each component after that first one.
On this page
CMS RVU26D · Effective 2026-10-01
90461 Vaccine administration Medicare reimbursement rates in Kentucky
Report 90461 for each vaccine component beyond the first when a patient age 18 or younger receives immunization administration with physician or qualified professional counseling. Compare 90461 office and facility rates across CMS payment localities in Kentucky.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 90461 in Kentucky?
Kentucky has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$8.40
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Immunization administration
About 90461: Additional vaccine component administration
Report 90461 for each vaccine component beyond the first when a patient age 18 or younger receives immunization administration with physician or qualified professional counseling.
Code 90461 represents administration of an additional vaccine component for a patient age 18 or younger when a physician or other qualified health care professional provides immunization counseling. It is commonly relevant when a combination vaccine contains multiple components. The code counts components, not injections, so a single injection can involve more than one reportable component. The physician or qualified health care professional may provide the service in an office, clinic, or other setting where pediatric immunizations are administered.
Report 90461 only with 90460, which represents the first component; use one unit of 90461 for each additional component. Documentation should support the patient's age, counseling by the physician or qualified professional, vaccine administered, and the component count. CMS classifies 90461 as an add-on code: it cannot be billed alone, and its payment is within the primary procedure's global period. Do not use it to count additional injections when the service is administration without the counseling framework.
CMS billing rules for 90461
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU0.18 · 69%
- Practice expense (office) RVU0.07 · 27%
- Malpractice RVU0.01 · 4%
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.
90461 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$20.24
90471 reports immunization administration without the age-based counseling framework. Use 90460 and, when applicable, 90461 when counseling by a physician or qualified health care professional is part of the service.
$14.82
90472 reports an additional immunization administration under the non-counseling framework. 90461 counts an additional vaccine component when the 90460 counseling framework applies.
Compare 90461 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Kentucky →
Office / nonfacility
$8.40
Facility
Unavailable
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 90461 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
11,413
- Code
- 90461
- Physician work
- 0.18
- Practice expense
- 0.07
- Malpractice
- 0.01
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.18 | × 1.000 | 0.1800 |
| Practice expense | 0.07 | × 0.889 | 0.0622 |
| Malpractice | 0.01 | × 0.915 | 0.0092 |
| Total RVUs | 0.2514 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$8.40
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.18 | 1 |
| Practice expense | 0.07 | 0.889 |
| Malpractice | 0.01 | 0.915 |
(0.18 × 1 + 0.07 × 0.889 + 0.01 × 0.915) × $33.4009 = $8.40
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
90461 billing questions
What is the difference between 90460 and 90461?
90460 represents the first vaccine component when the age and counseling requirements are met. Report 90461 for each additional component.
Can 90461 be billed without 90460?
No. CMS identifies 90461 as an add-on code, so it must be reported with its primary code, 90460.
Are units based on injections or vaccine components?
Units reflect additional vaccine components, not additional injections. A single injection of a combination vaccine may contain multiple components.
What documentation supports reporting 90461?
Document the patient's age, the vaccine administered and its component count, and counseling provided by a physician or other qualified health care professional.
When is 90472 a better fit?
90472 is for an additional immunization administration when the service is reported under the administration framework without the counseling requirements for 90460 and 90461. It counts an additional administration, not an additional vaccine component.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
11,41090396,,Varicella-zoster ig im,E,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
11,41190399,,Unlisted immune globulin,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
11,41290460,,Im admin 1st/only component,A,,0.23,0.45,,0.45,NA,0.02,0.70,0.70,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,41390461,,Im admin each addl component,A,,0.18,0.07,,0.07,NA,0.01,0.26,0.26,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,41490471,,Immunization admin,A,,0.17,0.48,,0.48,NA,0.01,0.66,0.66,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,41590472,,Immunization admin each add,A,,0.15,0.32,,0.32,NA,0.01,0.48,0.48,5,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,41690473,,Immune admin oral/nasal,A,,0.17,0.34,,0.34,NA,0.01,0.52,0.52,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631