90472 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 90472

Payer coverage policies that name 90472

90472 appears in 15 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, BlueCross BlueShield of South Carolina.

PayerPolicyRole in policyReviewedDocument
AetnaAnthrax (0483)listed, no stanceJul 29, 2026payer document
AetnaDengue Vaccine (1010)listed, no stanceFeb 25, 2026payer document
AetnaDiphtheria, Tetanus, and Pertussis Vaccines (0653)covered if criteria are metSep 25, 2026payer document
AetnaHuman Papillomavirus (HPV) Vaccine (0726)listed, no stanceNov 25, 2025payer document
AetnaInfertility (0327)listed, no stance (range 90471-90472)Jul 16, 2026payer document
AetnaInfluenza Vaccines (0035)listed, no stanceOct 8, 2026payer document
AetnaInjectable Medications (0020)listed, no stanceMar 5, 2026payer document
AetnaOrthopoxvirus Vaccines (0644)listed, no stanceSep 25, 2026payer document
AetnaPneumococcal Vaccines (0037)listed, no stanceOct 6, 2026payer document
AetnaPolio Vaccine (0402)listed, no stanceJul 7, 2026payer document
AetnaRespiratory Syncytial Virus (RSV) Vaccines for Adult and Maternal Use (1027)listed, no stanceOct 9, 2026payer document
AetnaSipuleucel-T (Provenge) (0802)not covered (range 90471-90472)Dec 22, 2025payer document
AetnaVaccines for Travel (0473)listed, no stanceJul 24, 2026payer document
Blue Cross & Blue Shield of Rhode IslandImmunizations Adult and Pediatric
products		covered if criteria are metJun 9, 2026payer document
BlueCross BlueShield of South CarolinaPreventive Services for Non-Grandfathered (PPACA) Plans: Immunizations (CAM 109)listed, no stanceApr 1, 2026payer document

Medicaid fee-for-service

  • AZ: $26.05 (outpatient_hospital), effective Oct 1, 2013
  • CO: $12.04 (chp_plus_immunizations), effective Jul 1, 2026
  • FL: $10.00 (immunization), effective Jul 1, 2026
  • IN: $11.36 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $14.15 (default), effective Sep 1, 2005
  • KY: $9.80 (physician, facility), effective Jan 1, 2026
  • LA: $11.50 (immunization_0_18), effective Jul 1, 2025
  • MA: $9.84 (physician_medicine), effective May 1, 2024
  • MS: $13.08 (comprehensive, PCP with EP modifier), effective Jul 1, 2023
  • ND: $18.28 (physician), effective Aug 1, 2026
  • NY: $13.95 (midwife, non-facility), effective Jul 1, 2026
  • OH: $9.85 (outpatient_hospital_behavioral), effective Jul 26, 2022
  • OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
  • TX: $10.38 (certified_nurse_midwife_cnm, Certified Nurse Midwife (Cnm), non-facility), effective Sep 1, 2022
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $11.44 (enhanced_adult, facility), effective Jul 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.