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    v1.0.28
    OpenPayerBilling CodesVaccines, ToxoidsCPT cpt-90635-h5n1-cell-culture-adjuvanted-influenza-vaccine-injection
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    CPT 90635: H5N1 Cell-Culture Adjuvanted Influenza Vaccine

    CPT code 90635 describes an H5N1 influenza (bird flu) vaccine manufactured in cell culture and formulated with an adjuvant, administered as an intramuscular injection; this preventive vaccine service is provided in outpatient and clinic settings such as physician offices, public health clinics, and immunization sites where injectable vaccines are given.

    For related coverage guidance, see recent payer policy updates: B-Hemolytic Streptococcus Testing, Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance Assays, Hepatitis Testing (A, B, C, D) Coverage Criteria.

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    Clinical & Coding Specifications

    Clinical Context

    A 42-year-old adult with occupational exposure to poultry presents to an outpatient clinic during a targeted H5N1 vaccination campaign. The patient is medically stable, consents to vaccination, and has no contraindications such as severe allergic reaction to prior H5N1 vaccine components. The clinic verifies identity and insurance, reviews immunization history, screens for acute illness and allergies, documents informed consent, and performs a brief medication/allergy review. The vaccine product, an H5N1 cell culture–derived, adjuvanted intramuscular formulation coded as 90635, is prepared per manufacturer instructions. The vaccine is administered intramuscularly, typically in the deltoid muscle, using standard aseptic technique. Post-vaccination observation for 15–30 minutes occurs to monitor for immediate adverse reactions. The encounter documentation includes vaccine lot number, expiration date, administration site, route, dose, informed consent, and any observed immediate reactions. Billing uses 90635 for the vaccine; applicable modifiers such as 52 (reduced services) or 53 (discontinued procedure) are appended when clinically appropriate. Typical sites of service are outpatient primary care clinics, occupational health clinics, public health clinics, and designated vaccination centers. This workflow applies to adult immunization visits, occupational risk mitigation programs, and targeted public health vaccination efforts during an H5N1 outbreak or preparedness campaign.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    90471Immunization administration (single vaccine) for intramuscular or subcutaneous injection; first or only componentUsed to bill the administration service when 90635 is given to an individual patient in an office or clinic
    90472Immunization administration (each additional vaccine)Used if 90635 is administered along with another injectable vaccine during the same visit
    99070Supplies and materials provided by the physician over and above those usually included with the office visitUsed for non-billable vaccine-related supplies when allowed by payer policy
    90460Immunization administration via any route, with counseling by physician or other qualified health care professional, first vaccine/toxoid component of each vaccine or toxoid administeredUsed when significant counseling about the vaccine is provided and billing rules allow counseling-based vaccine administration coding

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    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…
    57CPT® modifier -57 (“Decision for Surgery”) is appended to an Evaluation and Management (E/M) service when that encounter results in the initial decision to perform a major surgery (a procedure with a…- Use modifier 57 when an E/M service provided by the same provider (or same tax ID) on the day of or the day before a major surgical procedure (90‑day global period) results in the initial decision…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    207Q00000XFamily Medicine PhysicianFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    2471B0102XBone Densitometry Radiologic TechnologistA radiologic technologist who specializes in bone densitometry and is appropriately educated and trained, consistent with nationally recognized standa…
    172A00000XDriverA person employed to operate a motor vehicle as a carrier of persons or property.
    207XX0801XOrthopaedic Trauma PhysicianRecognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic trauma surgeons deal with the eval…
    1223X0008XOral and Maxillofacial Radiology DentistryThe specialty of dentistry and discipline of radiology concerned with the production and interpretation of images and data produced by all modalities …
    163WG0100XGastroenterology Registered NurseNursing Service Providers · Registered Nurse

    Related Payer Policy Updates

    Specialty: Infectious Disease1 / 3

    9 rows

    PolicyPayerEffective Date
    B-Hemolytic Streptococcus TestingOscar Health2026-10-01
    Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance AssaysOscar Health2026-10-01
    Hepatitis Testing (A, B, C, D) Coverage CriteriaOscar Health2026-10-01
    Lyme Disease Testing Coverage CriteriaOscar Health2026-10-01
    Pathogen Panel TestingOscar Health2026-10-01
    Diagnostic Testing of Common Sexually Transmitted InfectionsOscar Health2026-10-01
    Coronavirus Testing in the Outpatient SettingOscar Health2026-10-01
    Testing for Diagnosis of Active or Latent TuberculosisOscar Health2026-10-01
    Testing for Vector-Borne InfectionsOscar Health2026-10-01

    Related Codes

    CPT-90476-ADENOVIRUS-TYPE-4-ORAL-VACCINE-ADMINISTRATION

    CPT 90476: Oral Live Vaccine for Adenovirus Type 4

    CPT-90477-ORAL-LIVE-ADENOVIRUS-TYPE-7-VACCINE

    CPT 90477: Oral Live Adenovirus Type 7 Vaccine Administration

    CPT-90581-ANTHRAX-VACCINE-INJECTION

    CPT 90581: Anthrax Vaccine, Injection

    CPT-90584-QUADRIVALENT-LIVE-DENGUE-VACCINE-SUBCUTANEOUS

    CPT 90584: Quadrivalent Live Dengue Vaccine, Subcutaneous, Two-Dose

    CPT-90585-TB-LIVE-INTRADERMAL-VACCINE

    CPT 90585: Live Tuberculosis Vaccine Administered Through the Skin

    CPT-90586-INTRAVESICAL-LIVE-VACCINE-BLADDER-CANCER

    CPT 90586: Intravesical Live Vaccine for Bladder Cancer

    CPT-90587-DENGUE-VACCINE-SUBCUTANEOUS-THREE-DOSE

    CPT 90587: Quadrivalent Live Dengue Vaccine, Subcutaneous, Three-Dose

    CPT-90589-CHIKUNGUNYA-VACCINE-INTRAMUSCULAR-LIVE-ATTENUATED

    CPT 90589: Chikungunya Vaccine, Live Attenuated, Intramuscular

    CPT-90593-RECOMBINANT-CHIKUNGUNYA-VACCINE-INTRAMUSCULAR

    CPT 90593: Recombinant Chikungunya Vaccine, Intramuscular

    CPT-90611-SMALLPOX-MONKEYPOX-VACCINE-SUBCUTANEOUS-05ML

    CPT 90611: Combined Smallpox and Monkeypox Vaccine, Subcutaneous 0.5 mL

    Showing 1–10 of 101

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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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