`90477` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 90477

Payer coverage policies that name 90477

90477 appears in 1 coverage policy from Blue Cross & Blue Shield of Rhode Island.

Payer	Policy	Role in policy	Reviewed	Document
Blue Cross & Blue Shield of Rhode Island	Immunizations Adult and Pediatric	covered if criteria are met	Jun 9, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

CO: $38.48 (chp_plus_immunizations), effective Jul 1, 2026
ND: $0.00 (physician), effective Aug 1, 2026
TX: $27.29 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Oct 1, 2023
VT: $0.00 (outpatient_hospital_opps), effective Feb 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.

90477 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 90477

Payer coverage policies that name 90477

Medicaid fee-for-service

`90477` CPT® code: payer coverage and prior authorization