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See a sample rate comparisonCPT 90461 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Inadm Any Route Addl Vac/Tox, Immunization Administration Through 18 Years Of Age Via Any Route Of Administration With Counseling By Physician Or Other Qualified Health Care Professional; Each Additional Vaccine Or Toxoid Component Administered (List Separately In Addition To Code For Primary Procedure)
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Immunization Administration for Vaccines/Toxoids |
| Common Place of Service | 11 - Office 50 - Federally Qualified Health Center |
| Common Modifiers | SL 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $8.68 national non-facility rate (2026) · View Medicare rates for 90461 |
| Medicaid Fee Schedule | $7.20 median of the 8 states in the free preview · View Medicaid rates for 90461 |
National average reimbursement for CPT 90461 by major payers:
$14.17
$14.63
$10.80
$24.65
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CPT 90461
5 of 25 sample ratesHigher to lower in this preview
Arjun Bamzai
$36.75Published rateAnne Beressi
$17.04Published rateJames Towery
Birmingham Heart Clinic, PC
$12.98Published rateJeffrey Anderson
Cardiology Consultants, P.C.
$11.68Published rateApex Cardiology, PC
$7.26Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 90461 vs. Other Immunization Administration for Vaccines/Toxoids Codes
The CPT 90461 code is part of the Medicine Services and Procedures services used for Immunization Administration for Vaccines/Toxoids. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 90461 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 90460-CPT | Low | Im Admin 1st Only Component, Immunization Administration Through 18 Years Of Age Via Any Route Of Administration With Counseling By Physician Or Other Qualified Health Care Professional First Or Only Component Of Each Vaccine Or Toxoid Administered |
| 90461-CPT | Low | Inadm Any Route Addl Vac/Tox, Immunization Administration Through 18 Years Of Age Via Any Route Of Administration With Counseling By Physician Or Other Qualified Health Care Professional; Each Additional Vaccine Or Toxoid Component Administered (List Separately In Addition To Code For Primary Procedure) |
| 90471-CPT | Low | Immunization Administration (I, Immunization Administration (Includes Percutaneousintradermal Subcutaneous Intramuscular And Jet Injections Andor Intranasal Or Oral Administration) Single Or |
| 90472-CPT | Low | Immunization Admin Each Add, Immunization Administration Includes Percutaneous Intradermal Subcutaneous Or Intramuscular Injections Each Additional Vaccine Single Or Combination Vaccine Toxoid List Separately In Addition To Code For Primary Procedure |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90461. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90461 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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