2025 CPT code 90686

Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative-free, 0.5 mL dosage, for intramuscular use.

Follow all relevant CPT coding guidelines for vaccines.Report the administration code (e.g., 90460, 90461) separately.Do not code each component of a combination vaccine separately.

Modifiers may apply in specific circumstances, such as when a reduced service is provided (modifier 52) or if the procedure is discontinued (modifier 53). Consult the CPT manual and payer guidelines for appropriate modifier usage.

Annual influenza vaccination is medically necessary to protect individuals from influenza infection, especially high-risk groups. Documentation should justify the need for vaccination based on the patient's age, health status, and risk factors.

The administering provider is responsible for patient education regarding risks, benefits, and potential side effects of the vaccine before administration.The provider must also ensure proper preparation and injection technique for intramuscular administration.

IMPORTANT Separate codes exist for combination vaccines. If a specific vaccine code isn't available, use the unlisted procedure code.

In simple words: This code is for a flu shot that protects against four types of flu.It's a preservative-free injection given into a muscle.

CPT code 90686 represents the administration of a quadrivalent influenza virus vaccine (IIV4) that is split-virus, preservative-free, and comes in a 0.5 mL dose for intramuscular injection.This vaccine protects against four strains of influenza virus.The code's use requires appropriate documentation specifying the vaccine administered, route of administration (intramuscular), and the clinical indication for its use.

Example 1: A 35-year-old presents for their annual influenza vaccination.The provider administers 0.5mL of the quadrivalent, split-virus, preservative-free influenza vaccine intramuscularly. Code 90686 is reported along with the appropriate administration code (e.g., 90460, 90461)., A 68-year-old patient with multiple comorbidities receives a quadrivalent influenza vaccination.The provider administers 0.5 mL of the vaccine intramuscularly. Code 90686 is reported along with the administration code.Documentation should highlight the patient's risk factors and the rationale for the vaccination., A pediatric patient receives their influenza vaccination.The provider administers 0.5 mL of the vaccine intramuscularly.Code 90686 is reported with the administration code and appropriate age-related documentation.

* Patient demographics.* Date of administration.* Vaccine product administered (manufacturer and lot number).* Dosage (0.5 mL).* Route of administration (intramuscular).* Documentation of patient education regarding risks, benefits, and potential side effects.* Any adverse events experienced.

** Always refer to the most current CPT codebook and payer guidelines for the most up-to-date information on coding and reimbursement.NDC codes (National Drug Codes) for specific manufacturers' products should be documented.

  • Revenue Code: O1G (Influenza Immunization)
  • RVU: This information is not available in the provided text.RVUs vary based on geographic location and other factors. Consult your local fee schedule.
  • Payment Status: Active
  • Modifier TC rule: No Technical Component (TC) modifier applies to code 90686.
  • Fee Schedule : This information is not available in the provided text. Consult your local fee schedule or other relevant payment resources.
  • Specialties:Family Medicine, Internal Medicine, Pediatrics, Occupational Medicine
  • Place of Service:Office, Clinic, Hospital, Other
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