How much does Medicare pay for CPT 90472?

Medicare allowed an average of $13.94 per service and paid $9.87 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $31.94, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 90472?

Administration of vaccine, each additional vaccine. It was billed 4,180 times to 2,976 Medicare beneficiaries by 125 providers in 2024.

Which specialty bills 90472 most?

Family Practice, with 1,188 services from 55 clinicians. Next are Internal Medicine, Infectious Disease, Nurse Practitioner.

CPT 90472

Administration of vaccine, each additional vaccine

$13.94Medicare-allowed amount per service, averaged across 4,180 services

Providers submitted

$31.94

Asking price, not received

Medicare allowed

$13.94

The fee schedule figure

Medicare paid

$9.87

Balance is patient coinsurance

Providers submitted an average of $31.94 for this code and Medicare allowed $13.94 — 2.3× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $9.87 (71%); the rest is the patient’s coinsurance and deductible.

Services: 4,180
Beneficiaries: 2,976
Providers billing it: 125
Total allowed: $58,269

What Medicare pays for CPT 90472

Across 4,180 services billed by 125 providers to 2,976 beneficiaries, Medicare allowed an average of $13.94 per service. That is 1.4 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 90472

Specialty	Services	Beneficiaries	Avg allowed	Providers
Family Practice	1,188	953	$14.35	55
Internal Medicine	810	669	$14.65	32
Infectious Disease	550	325	$13.37	7
Nurse Practitioner	450	362	$12.93	15
Centralized Flu	289	272	$13.86	1
Pediatric Medicine	280	155	$12.56	3
Medical Oncology	219	47	$14.20	2
Hematology-Oncology	190	40	$14.06	2
Gastroenterology	92	72	$15.22	3
Physician Assistant	81	56	$12.16	3
Osteopathic Manipulative Medicine	17	11	$16.59	1
Emergency Medicine	14	14	$13.73	1

90472 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Texas	760	$13.58	$10.28	12
Florida	441	$13.90	$13.26	6
Maryland	428	$14.27	$9.38	14
Arkansas	421	$12.41	$8.68	5
Pennsylvania	266	$14.10	$9.71	12
North Carolina	253	$13.59	$9.96	11
Georgia	223	$13.85	$9.74	6
New Jersey	210	$16.28	$10.41	5
Colorado	147	$14.37	$8.31	6
New York	128	$15.12	$10.25	5
Louisiana	103	$13.35	$10.04	5
Michigan	99	$14.21	$10.71	3
Virginia	90	$16.17	$9.82	5
Illinois	86	$14.15	$10.32	2
Oklahoma	70	$13.52	$10.44	4
New Mexico	57	$14.77	$8.55	2
District of Columbia	47	$15.78	$10.23	2
Tennessee	45	$13.36	$7.78	3
Nevada	37	$14.70	$10.11	2
California	35	$15.37	$11.11	2
New Hampshire	35	$13.30	$7.74	2
Delaware	31	$12.22	$9.24	1
Wisconsin	29	$11.75	$8.16	1
North Dakota	20	$14.25	$10.34	1
Mississippi	17	$13.00	$10.30	1
Washington	17	$16.59	$11.48	1
Wyoming	16	$13.62	$10.81	1
Idaho	16	$11.43	$7.54	1
Kentucky	15	$11.30	$6.82	1
Alaska	14	$14.97	$7.79	1
Alabama	13	$11.82	$10.78	1
South Carolina	11	$13.57	$10.51	1

Related codes

90480Admn sarscov2 vacc 1 dose$37.99
90471Administration of vaccine$19.61

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.