CPT 90649: Quadrivalent HPV Vaccine, Intramuscular - OpenPayer

Summary & Overview

CPT 90649: Quadrivalent HPV Vaccine, Intramuscular

CPT code 90649 denotes a quadrivalent human papillomavirus vaccine administered intramuscularly in a three-dose series to protect against HPV types 6, 11, 16, and 18. Nationally, HPV vaccination is a key preventive service that reduces incidence of HPV-related genital warts and certain cancers; billing clarity for vaccine products like 90649 supports consistent delivery and claims processing across providers and payers. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise overview of the clinical purpose and usual administration context for CPT code 90649, plus guidance on typical sites of service and common billing considerations. The publication covers payer coverage patterns and benchmarks where available, recent policy updates affecting vaccine reimbursement and administration, and relevant clinical context for the three-dose schedule. Data limitations are noted where input information is incomplete. The goal is to provide national-level clarity on the use and billing of CPT code 90649 to inform provider billing workflows and payer discussions.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare90649CPTHPV vaccineimmunizationvaccine administrationpreventive careoutpatientpediatricspublic health

Billing Code Overview

CPT code 90649 represents a quadrivalent human papillomavirus (HPV) vaccine product administered intramuscularly to prevent infection with HPV types 6, 11, 16, and 18. The vaccine is provided as a three-dose series and is intended for active immunization against HPV-related disease.

Service Type

Vaccine administration (intramuscular immunization)

Typical Site of Service

Outpatient clinics, including primary care and pediatric offices
Public health clinics and community vaccination centers
School-based health clinics
Ambulatory care sites

Clinical & Coding Specifications

Clinical Context

A 16-year-old adolescent presents to a primary care clinic for routine immunizations. The patient has no acute illness, screening for contraindications is completed, and the clinician documents informed consent. The vaccine administered is a quadrivalent human papillomavirus vaccine given intramuscularly following a three-dose schedule at 0, 1–2, and 6 months. Typical workflow: intake and immunization record review, vaccine screening for contraindications/allergies, documentation of lot number and manufacturer, intramuscular administration (usually deltoid), observation for 15 minutes for adverse reactions, and entry of the administration into the electronic health record and immunization registry. Billing uses 90649 for the vaccine product; appointment type is preventive or immunization visit, commonly performed in outpatient primary care clinics, pediatric offices, community health centers, and public health clinics.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier	Used when no applicable modifier is required for the service billed.
`11`	Professional component

CPT 90477: Live Oral Vaccine for Adenovirus Type 7

cpt-90661-intramuscular-trivalent-influenza-vaccine-05-ml

CPT 90661: Intramuscular Trivalent Influenza Vaccine, 0.5 mL

cpt-90756-quadrivalent-cell-derived-influenza-vaccine-0-5-ml-im-immunization

CPT 90756: Quadrivalent Cell-Derived Influenza Vaccine, 0.5 mL Intramuscular

cpt-90716-varicella-vaccine-subcutaneous-administration

CPT 90716: Varicella Vaccine, Subcutaneous Administration

cpt-90657-trivalent-influenza-vaccine-split-virus-025ml-im-im

CPT 90657: Trivalent Influenza Vaccine, Split Virus, 0.25 mL IM

cpt-90656-trivalent-influenza-vaccine-preservative-free

CPT 90656: Trivalent Influenza Vaccine, Preservative‑Free, 0.5 mL

cpt-90666-preservative-free-pandemic-influenza-split-virus-immunization

CPT 90666: Preservative-Free Pandemic Influenza Vaccine, Split Virus

cpt-90662-influenza-split-virus-preservative-free-high-antigen-immunization

CPT 90662: Influenza Vaccine, Split Virus, Preservative-Free, High Antigen

cpt-90593-recombinant-chikungunya-vaccine-intramuscular

CPT 90593: Recombinant Chikungunya Vaccine, Intramuscular

cpt-90714-diphtheria-tetanus-preservative-free-immunization-im

CPT 90714: Diphtheria and Tetanus Preservative‑Free Vaccine IM

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Taxonomy Code	Specialty	Notes
207Q00000X	Family Medicine	Primary care clinicians who routinely administer vaccines.
208000000X	Pediatrics	Pediatricians providing immunizations for adolescents and children.
363A00000X	Public Health	Public health clinic staff administering population immunization programs.
207R00000X	Internal Medicine	Internists who administer vaccines to adolescent and adult patients.
261QM0800X	Nurse Practitioner	Advanced practice providers who commonly administer vaccines in outpatient settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z23`	Encounter for immunization	Primary diagnosis code used when administering `90649` for routine vaccination visits.
`Z00.129`	Encounter for routine child health examination without abnormal findings	Used when vaccine given during well-child visit.
`Z00.121`	Encounter for routine pediatric preventive health examination with abnormal findings	Used when vaccine is given during preventive visit with pertinent findings.
`Z71.89`	Other specified counseling	When vaccine counseling is provided and documented.
`T88.1XXA`	Other complications following immunization, initial encounter	Used if the patient experiences an adverse reaction that requires encounter documentation.
`Z23.5`	Encounter for vaccination against human papillomavirus	Specific encounter code variant used in some coding systems to denote HPV vaccination.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90460`	Immunization administration through 18 years of age via any route, with counseling by physician or other qualified health care professional; first or only component of each vaccine/toxoid administered	Use when separate counseling is provided and billed for the vaccine administration to pediatric/adolescent patients.
`90461`	Immunization administration through 18 years of age, each additional vaccine/toxoid component	Billed when multiple vaccines are administered during the same visit in patients under 19.
`90471`	Immunization administration (single vaccine) intramuscular or subcutaneous	Alternative administration code used when billing only the administration (not vaccine product) for a single dose in patients 19 years and older.
`90472`	Immunization administration each additional vaccine (single or combination vaccine)	Used when more than one vaccine is administered and the administration component is billed per additional vaccine.
`90715`	Tetanus, diphtheria toxoids, acellular pertussis vaccine (Tdap), intramuscular	Commonly co-administered during adolescent immunization visits; documented and billed separately if given.
`90633`	Hepatitis B vaccine, adolescent or pediatric dosage, 2-dose schedule, when applicable	May be administered during the same visit and billed separately if given alongside the HPV vaccine.

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