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    v1.0.28
    OpenPayerBilling CodesTherapeutic, Preventive or Other InterventionsCPT cpt-4035f-influenza-vaccine-recommendation-ibd
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    CPT 4035F: Influenza Vaccine Recommendation for IBD Patients

    CPT code 4035F indicates that the provider recommends influenza vaccination to provide protection against influenza for a patient with chronic inflammatory bowel disease, specifying a preventive counseling or recommendation service related to immunization; service type: vaccine recommendation/preventive counseling; typical site of service: outpatient clinic or ambulatory care setting where immunization counseling is provided.

    For related coverage guidance, see recent payer policy updates: Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA), Cardiovascular Disease Risk Assessment, Biomarkers for Myocardial Infarction and Chronic Heart Failure.

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    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:

    • Patient check‑in and medication list review

    • Immunization history verification and screening for contraindications

    • Provider assessment and documentation of recommendation for influenza vaccination (4035F description applies)

    • Patient counseling and shared decision discussion documented

    • Scheduling or administration of influenza vaccine by nursing staff or referral to pharmacy

    • Documentation of administration, lot number, and any adverse event monitoring in the medical record

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    90686Influenza virus vaccine, quadrivalent, preservative free, for intramuscular useCommon vaccine product administered after recommendation documented under 4035F

    90460 | Intramuscular or subcutaneous immunization administration (includes percutaneous, intradermal), with counseling when performed; first vaccine/toxoid component | Used to report the act of vaccine administration when counseling is provided

    90461 | Each additional vaccine/toxoid component administered (List separately in addition to code for primary service) | Used if multiple vaccine components are administered in the same encounter

    99401 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (approximately 15 minutes) | Reported when significant preventive counseling about influenza and risks is provided (per payer rules)

    G0008 | Administration of influenza virus vaccine | Medicare-specific code used for reporting influenza vaccine administration in the outpatient setting

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    33Modifier 33 was created by the American Medical Association in response to the Affordable Care Act to identify services provided for preventive intent. It is appended to CPT/HCPCS codes that could be…- Use modifier -33 when a CPT/HCPCS service that can be billed as either preventive or diagnostic/treatment is provided with preventive intent and aligns with USPSTF A or B recommendations or other…
    58Modifier 58 (Staged or related procedure/service by the same physician during the postoperative period) indicates that a subsequent procedure performed by the same provider during the…- Use modifier 58 when the same physician/QHP performs a procedure during the postoperative/global period of an earlier procedure and the subsequent procedure is either planned or anticipated…
    3PThe CPT Category II modifier -3P denotes a performance‑measure exclusion when a required quality action was not performed because of system‑level constraints. It is appended only to Category II…- When to apply: Use CPT Category II modifier 3P only with Category II (‘‘F’’) codes when a specific quality measure’s specifications allow a system‑level exclusion — append 3P to indicate the…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207RG0100XGastroenterology PhysicianAn internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This…
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    207K00000XAllergy & Immunology PhysicianAn allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
    364S00000XClinical Nurse SpecialistA registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses…
    367500000XCertified Registered Nurse Anesthetist(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, prov…
    103TR0400XRehabilitation PsychologistA psychologist who specializes in the study and application of psychological principles on behalf of persons who have disability due to injury or illn…
    207ZD0900XDermatopathology (Pathology) PhysicianA dermatopathologist is an expert in diagnosing and monitoring diseases of the skin including infectious, immunologic, degenerative, and neoplastic di…
    1710I1003XIndependent Duty Medical TechniciansAn Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatmen…

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    B20Human immunodeficiency virus [HIV] disease
    D69.6Thrombocytopenia, unspecified
    D73.3Abscess of spleen
    E11.9Type 2 diabetes mellitus without complications
    E66.9Obesity, unspecified
    I10Essential (primary) hypertension
    J44.9Chronic obstructive pulmonary disease, unspecified
    J45.909Unspecified asthma, uncomplicated
    K50.00Crohn's disease of small intestine without complications
    K50.10Crohn's disease of large intestine without complications

    Showing 1–10 of 27

    Related Payer Policy Updates

    Specialty: Cardiology1 / 3

    6 rows

    PolicyPayerEffective Date
    Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA)univerahealthcare2026-10-15
    Cardiovascular Disease Risk AssessmentOscar Health2026-10-01
    Biomarkers for Myocardial Infarction and Chronic Heart FailureOscar Health2026-10-01
    Multiple Procedure Payment Reduction for Diagnostic Cardiovascular ProceduresBlue Cross Blue Shield - Maine2026-10-01
    Cardiovascular Disease Risk Assessmentblue cross blue shield - louisiana2026-09-15
    Cardiovascular Disease Risk AssessmentBlue Cross Blue Shield - New Mexico2026-09-04

    Related Codes

    CPT-4000F-ASTHMA-TOBACCO-EXPOSURE-COUNSELING

    CPT 4000F: Asthma-Related Tobacco Exposure and Counseling

    CPT-4001F-ASTHMA-TOBACCO-EXPOSURE-SMOKING-CESSATION-MEDICATION-DISCUSSION

    CPT 4001F: Asthma Patient Tobacco Exposure and Smoking Cessation Discussion

    CPT-4003F-UNDEFINED-MEASURE

    CPT 4003F: Preventive Counseling or Risk-Factor Intervention

    CPT-4004F-TOBACCO-USE-SCREENING-AND-CESSATION-OFFER-ADULT

    CPT 4004F: Tobacco Use Screening and Offer of Cessation for Adults

    CPT-4005F-UNKNOWN-SERVICE

    CPT 4005F: No Summary found

    CPT-4008F-UNKNOWN-SERVICE

    CPT 4008F: No Summary available

    CPT-4010F-ACE-INHIBITOR-ARB-THERAPY-DOCUMENTATION

    CPT 4010F: ACE Inhibitor or ARB Therapy Prescribed or Current

    CPT-4011F-ANTIPLATELET-THERAPY-PRESCRIPTION-MANAGEMENT

    CPT 4011F: Prescription for Antiplatelet Therapy

    CPT-4012F-UNCATEGORIZED-PROCEDURE

    CPT 4012F: No Summary Available

    CPT-4013F-STATIN-THERAPY-PRESCRIPTION-OR-CURRENT-USE

    CPT 4013F: Statin Therapy Prescription or Current Use

    Showing 1–10 of 175

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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