Summary & Overview
CPT 90626: Tick-Borne Encephalitis Vaccine, Intramuscular 0.25 mL
Headline: CPT code 90626: Tick-borne Encephalitis Inactivated Vaccine, 0.25 mL
Lead: CPT code 90626 identifies an inactivated tick-borne encephalitis vaccine supplied as a 0.25 mL intramuscular dose. This vaccine code is used in outpatient vaccination settings to prevent viral encephalitis transmitted by ticks and is relevant for clinicians, billing staff, and payers involved in travel medicine and preventive immunization services.
Why it matters nationally: Protection against tick-borne viral encephalitis is a public health priority in regions with endemic transmission and for travelers to affected areas. Accurate use of CPT code 90626 supports appropriate claims submission, population-level immunization tracking, and vaccine access across payer networks.
Key payers covered: The analysis addresses reimbursement and coverage considerations across major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication provides clinical context for the vaccine and its typical delivery in outpatient settings, common billing considerations associated with vaccine administration, an overview of payer coverage patterns, and benchmark information where available. It also summarizes common modifiers used in vaccine billing and notes where input data were unavailable.
Data limitations: Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and detailed payer-specific coverage policies.
Billing Code Overview
CPT code 90626 represents an inactivated tick-borne encephalitis vaccine administered intramuscularly in a 0.25 mL dosage. The service is a vaccine administration intended to protect against viral encephalitis transmitted by ticks.
Typical site of service: ambulatory clinic, primary care office, travel medicine clinic, or other outpatient vaccination settings.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 55-year-old outdoor worker or traveler who presents to a primary care clinic, occupational health clinic, or travel medicine clinic during tick season seeking protection against tick-borne viral encephalitis. The clinical workflow includes verification of immunization history, review of contraindications (e.g., severe allergic reaction to a prior dose or vaccine component), informed consent, and documentation of vaccine lot number and site. The 90626 vaccine (0.25 mL intramuscular) is administered in the deltoid, post-vaccination observation for immediate adverse reactions is performed (typically 15 minutes), and the encounter is documented in the patient medical record and immunization registry as appropriate. Billing is submitted using 90626 with applicable modifier(s) when circumstances such as unusual procedural services, patient condition, or payer requirements apply. Typical sites of service include primary care offices, occupational health clinics, public health clinics, travel medicine clinics, and outpatient hospital clinics.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier used/standard reporting | Use when no special circumstances require a modifier and the service is reported normally. |