`90481` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 90481

Payer coverage policies that name 90481

90481 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 products	covered if criteria are met	Jun 9, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

CO: $0.00 (immunizations), effective Jul 1, 2026
ND: $0.00 (physician), effective Aug 1, 2026
NE: $15.00 (physician, non-facility), effective Jul 1, 2026
OH: $33.71 (provider_administered_drugs), effective Jan 1, 2026
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.

90481 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 90481

Payer coverage policies that name 90481

Medicaid fee-for-service

`90481` CPT® code: payer coverage and prior authorization