Summary & Overview
CPT 90637: Quadrivalent mRNA Influenza Vaccine, 30 mcg/0.5 mL
CPT code 90637 denotes a quadrivalent, mRNA-based influenza vaccine delivered by intramuscular injection at a dosage of 30 mcg/0.5 mL. As an influenza immunization option, this vaccine contributes to national seasonal influenza prevention efforts, reducing morbidity and health system burden associated with influenza outbreaks. The code is relevant across outpatient and ambulatory settings where routine vaccinations occur, including primary care practices, retail pharmacies, and community vaccination clinics.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical description, payer coverage considerations, common billing modifiers, and guidance on typical service settings. The publication summarizes benchmark and policy context at a national level, outlines common administrative elements tied to vaccine billing, and highlights clinical context for vaccination programs. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 90637 represents a quadrivalent, mRNA–based influenza vaccine administered by intramuscular injection. The specified dosage for this vaccine is 30 mcg/0.5 mL. The primary clinical purpose of this service is to reduce the patient’s risk of contracting influenza during the influenza season.
Service Type: Vaccine administration (intramuscular)
Typical Site of Service: Outpatient clinics, primary care offices, pharmacies, community vaccination sites, and other ambulatory care settings where intramuscular vaccinations are delivered.
Clinical & Coding Specifications
Clinical Context
A 67-year-old patient presents to a primary care clinic during influenza season for routine immunization. The patient has a history of chronic obstructive pulmonary disease and diabetes mellitus and requests the annual influenza vaccine to reduce the risk of influenza infection and related complications. After verification of identity, allergy history (particularly egg or prior vaccine reactions), and informed consent, a licensed nurse prepares the quadrivalent mRNA influenza vaccine, 90637 (30 mcg/0.5 mL), and administers it via intramuscular injection into the deltoid. The nurse documents vaccine lot number, expiration date, site, route, manufacturer, and VIS (Vaccine Information Statement) administration in the medical record and the immunization registry as applicable. Billing is submitted under the patient’s primary medical benefit; encounter includes vaccine administration and counseling documentation. Typical site of service is an outpatient clinic, physician office, retail clinic, or community vaccination clinic. Common clinical workflow steps: patient check-in and screening, clinician review and consent, vaccine preparation and administration, post-vaccination observation (typically 15 minutes), documentation, and billing using 90637 with appropriate modifier if needed (e.g., payment adjustments or unusual circumstances).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |