CPT 90473 Fee Schedule
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.
| 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 • 71 - Public Health Clinic |
| Common Modifiers | • None • SL • EP - Residential facility to Physician's office |
| Complexity Level | Moderate |
National average reimbursement for CPT 90473 by major payers:
$21.90
$19.25
$12.67
$24.04
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 90473 | ||||||
United | 90473 | $24.64 | 1245360411 - ANDREW KULIK | 364340137 - (IL) SAINT ANTHONY HEALTH AFFILIATES | IL | Psychiatry Physician (2084P0800X) |
United | 90473 | $26.59 | 1710328703 - ALI ANWAR | 815143225 - (IL) COMMUNITY HOME PHYSICIANS LLC D/B/A COMMUNITY PHYSICIANS | MO | Psychiatry Physician (2084P0800X) |
United | 90473 | $15.72 | 1033347125 - DAVID HANRAHAN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | CA | Psychiatry Physician (2084P0800X) |
United | 90473 | $31.93 | 1891180170 - SURYA SABHAPATHY | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 90473 | $50.31 | 1992904197 - JOANNA BLACKBURN | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90473 | $19.00 | 1689787426 - KAREN SEVERSON | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | VA | Psychiatry Physician (2084P0800X) |
United | 90473 | $21.13 | 1225058332 - SHERRIE LEVY | 371140016 - CARLE HEALTH CARE INCORPORATED | IL | Psychiatry Physician (2084P0800X) |
United | 90473 | $29.94 | 1720087513 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 90473 | $15.42 | 1386969079 - ADAM WALLACE | 362222696 - SWEDISHAMERICAN HOSPITAL | MN | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90473 | $18.13 | 1073697132 - FEDRA NAJJAR | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90473 | $23.25 | 1144267865 - NITIN PATEL | 462706345 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90473 | $23.29 | 1558867523 - SULAIMAN FAROOQUI | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90473 | $5.61 | 1366400376 - SUNRISE HOME HEALTH CARE INC. | 650307774 - (FL) SUNRISE HOME HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 90473 | $24.29 | 1912385295 - ALYSSA STRAM | 911780160 | NY | Psychiatry Physician (2084P0800X) |
United | 90473 | $15.42 | 1740252972 - DAVID HSU | 362222696 - SWEDISHAMERICAN HOSPITAL | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 90473 vs. Other Immunization Administration for Vaccines/Toxoids Codes
The CPT 90473 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 90473 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 | Low | 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 | Low | 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 |
| 90471 | Low | Immunization Administration (Includes Percutaneous Intradermal Subcutaneous Intramuscular And Jet Injections); One Vaccine (Single Or Combination Vaccine/Toxoid) |
| 90473 | Low | Immunization Administration By Intranasal Or Oral Route; One Vaccine |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90473. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90473 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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