Summary & Overview
CPT 4035F: Influenza Vaccine Recommendation for IBD Patients
CPT code 4035F records a clinician’s recommendation that a patient with chronic inflammatory bowel disease (IBD) receive the influenza vaccine to reduce risk of severe, potentially life‑threatening complications from influenza. As a performance code, it captures preventive counseling and vaccine recommendation for a medically vulnerable population rather than the vaccine administration transaction itself. Nationally, accurate documentation of this recommendation supports quality measurement, clinical risk mitigation for immunocompromised or chronically ill patients, and payer performance reporting. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical purpose of the code, typical service setting and workflows, and what stakeholders monitor for quality and compliance. The publication also summarizes common reporting use cases and highlights gaps where data were not provided. Data not available in the input include specific payer coverage rules, common modifiers, associated taxonomies, ICD‑10 diagnosis mappings, related codes, and service line details.
Billing Code Overview
CPT code 4035F documents that the provider recommends influenza vaccination to provide protection against influenza in a patient with chronic inflammatory bowel disease due to the risk of life‑threatening complications from this highly contagious respiratory virus. This entry captures the clinical recommendation rather than administration of the vaccine itself.
Service type: Preventive counseling / vaccination recommendation
Typical site of service: Outpatient clinic or outpatient specialty visit (gastroenterology or primary care)
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient with a 10-year history of Crohn disease presents to an outpatient gastroenterology clinic in late October. The patient is on maintenance immunosuppressive therapy with azathioprine and has intermittent corticosteroid use for flares. During triage, nursing documents that the patient has not yet received the current season influenza vaccine. The gastroenterologist reviews the immunization history, discusses the elevated risk of severe influenza and potential life‑threatening complications given the patient’s chronic inflammatory bowel disease and immunosuppression, and documents a clear recommendation for annual influenza vaccination. The recommendation is recorded in the electronic medical record, patient education handouts are provided, and the clinic schedules the vaccine administration appointment or refers the patient to an on‑site immunization nurse.
Typical workflow steps:
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Patient check‑in and medication list review
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Immunization history verification and screening for contraindications
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Provider assessment and documentation of recommendation for influenza vaccination (
4035Fdescription applies) -
Patient counseling and shared decision discussion documented
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Scheduling or administration of influenza vaccine by nursing staff or referral to pharmacy
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Documentation of administration, lot number, and any adverse event monitoring in the medical record