Summary & Overview
CPT 90613: Influenza and COVID-19 Combination Vaccine, IM
CPT code 90613 designates a combination intramuscular vaccine that delivers both a quadrivalent influenza vaccine and an mRNA COVID–19 vaccine in a single 0.4 mL (40 microgram) dose. As a bundled vaccine product, it simplifies administration by providing protection against seasonal influenza and COVID–19 with one injection, which has implications for immunization workflows, vaccine inventory management, and billing practices nationwide.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, billing considerations for combination vaccines, and the landscape of payer coverage and policy implications. The publication summarizes available benchmarks where present, notes common billing modifiers, and outlines typical sites of service and service type for deployment of the product.
This national-level summary is intended to inform health system administrators, billing staff, and policy analysts about the code’s clinical role, coding designation, and areas where payers and providers may need to align operationally. Data not available in the input is identified and not inferred.
Billing Code Overview
CPT code 90613 describes a combination intramuscular vaccine that protects against seasonal influenza and COVID–19. The product includes a quadrivalent influenza vaccine combined with an mRNA COVID–19 vaccine, delivered as a single 0.4 mL intramuscular dose containing a total of 40 micrograms of active ingredient.
Service Type: Combination vaccine administration, intramuscular
Typical Site of Service: Outpatient clinics, physician offices, pharmacy clinics, and community vaccination sites
Clinical & Coding Specifications
Clinical Context
A 68-year-old adult presents to a primary care clinic during fall vaccination season for routine immunizations. The patient has a history of chronic obstructive pulmonary disease (COPD) and hypertension and requests contemporaneous protection against seasonal influenza and COVID-19. The clinician verifies immunization history, reviews contraindications (e.g., severe prior allergic reaction to vaccine components), obtains informed consent, and documents the indication. The combined intramuscular vaccine product 90613 (quadrivalent influenza plus mRNA COVID-19, 40 mcg/0.4 mL) is prepared and administered into the deltoid muscle using aseptic technique. The patient is observed in the clinic for 15 minutes for immediate adverse reactions. Documentation includes vaccine lot number, manufacturer, expiration date, administration site and route, dosage, patient consent, and any post‑administration counseling. Billing is submitted to the patient’s payer with 90613 and any applicable modifier for unusual circumstances (e.g., increased procedural services), following payer-specific coverage rules.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the vaccine administration required substantially greater resources or time than typical (rare for routine IM vaccines) and documentation supports increased complexity. |