Summary & Overview

CPT 4037F: Influenza Vaccination for Patients with Inflammatory Bowel Disease

CPT code 4037F identifies ordering or administration of an influenza vaccine for patients undergoing treatment for inflammatory bowel disease (IBD). This code captures targeted preventive immunization in an at-risk population where influenza can lead to severe, potentially life-threatening complications. Nationally, accurate capture of such vaccination events supports patient safety, quality measurement, and immunization coverage tracking for immunocompromised patient groups.

Key payers relevant to this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, coding purpose, and expected sites of service. The publication summarizes common billing practices, payer coverage considerations, and related documentation needs. It also highlights benchmarks and policy updates affecting influenza vaccination measurement for patients with chronic immunomodulating conditions. Clinical context explains why vaccination is prioritized for patients receiving IBD therapy and how CPT code 4037F is used to reflect that preventive service in claims and quality reporting.

Data not available in the input: associated taxonomies, ICD-10 diagnoses, related codes, and service line specifics beyond the provided description.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare4037FCPTinfluenza vaccinationpreventive careinflammatory bowel diseaseimmunizationoutpatientquality measurement

Billing Code Overview

CPT code 4037F documents that the provider orders or administers an influenza vaccination for a patient receiving treatment for inflammatory bowel disease (IBD). The code emphasizes vaccination to reduce the risk of life-threatening complications from influenza in this immunologically vulnerable population.

Service Type

Preventive immunization aimed at influenza protection for patients undergoing treatment for inflammatory bowel disease.

Typical Site of Service

Outpatient clinic, infusion center, or other ambulatory care settings where patients with inflammatory bowel disease receive treatment and preventive care, including vaccination during routine visits or therapy sessions.

Clinical & Coding Specifications

Clinical Context

A 56-year-old patient with established moderate-to-severe inflammatory bowel disease (for example, Crohn disease) presents to a gastroenterology clinic during influenza season for ongoing biologic therapy. The patient is receiving maintenance infusions every 8 weeks and is immunomodulated with a tumor necrosis factor inhibitor. The gastroenterology nurse reviews vaccination history, documents absence of current-year influenza vaccination, verifies no contraindications (e.g., severe egg allergy or prior severe vaccine reaction), and the provider orders and administers an inactivated influenza vaccine during the clinic visit to reduce the risk of life-threatening influenza complications related to immunosuppression.

The clinical workflow includes pre-visit medication and allergy review, verification of vaccine availability and consent, documentation of vaccine lot number and site of administration in the medical record and immunization registry, application of appropriate billing modifier(s), and counseling the patient on expected adverse events and when to seek care.

Coding Specifications

Modifier	Description	When to Use
`00`	Default/No modifier	Used when no special circumstances or modifier-specific conditions apply to the billed vaccine administration.
`2P`

Taxonomy Code	Specialty	Notes
207RH0000X	Gastroenterology	Gastroenterologists manage inflammatory bowel disease and often order/administer vaccines during clinic visits.
207RC0000X	Colon & Rectal Surgery	Specialists who treat IBD patients, may provide vaccinations pre- or post-procedurally.
207RP3000X	Pediatric Gastroenterology	For adolescent patients with IBD receiving vaccines in specialty clinics.
207RN0300X	Adult Reconstructive Gastroenterology	Providers treating adult IBD patients in outpatient infusion clinics.
363L00000X	Nurse Practitioner	NPs in gastroenterology or infusion clinics frequently administer vaccinations and document coding.

ICD-10 Code	Description	Clinical Relevance
`K50.90`	Crohn disease, unspecified, without complications	Crohn disease patients on immunosuppressive therapy are at higher risk for severe influenza and are indicated for vaccination.
`K51.90`	Ulcerative colitis, unspecified, without complications	Ulcerative colitis patients, particularly if treated with immunosuppressants, require influenza vaccination to reduce complication risk.
`D70.9`	Neutropenia, unspecified	Patients with treatment-related neutropenia have increased infection risk; influenza vaccination is clinically relevant.
`D89.9`	Disorder involving the immune mechanism, unspecified	Generic immune dysfunction or immunosuppression indicates need for prioritized vaccination.
`Z79.899`	Other long term (current) drug therapy	Denotes ongoing immunosuppressive medication (for example, biologics) that increases influenza risk and supports vaccine administration.
`Z23`	Encounter for immunization	Used to indicate an encounter primarily for administration of the influenza vaccine.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90471`	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular); first vaccine/toxoid component, when given alone	Billed for the administration of a single intramuscular influenza vaccine when no counseling or additional components are billed.
`90472`	Immunization administration, each additional vaccine/toxoid component administered (List separately in addition to code for primary procedure)	Used if another vaccine is administered during the same encounter in addition to the influenza vaccine.
`90460`	Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component	Applicable when counseling accompanies vaccine administration for pediatric patients.
`90461`	Immunization administration through 18 years of age; each additional vaccine/toxoid component	Additional pediatric vaccine components administered same visit.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Common E/M code when a separate management visit is provided the same day as vaccine administration and meets documentation requirements.
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Alternative code some practices use for vaccine administration when payer policy requires; check payer guidelines.

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