Summary & Overview
CPT 90655: Preservative-Free Trivalent Influenza Vaccine, 0.25 mL IM
CPT code 90655 denotes a preservative‑free, trivalent influenza vaccine composed of split virus components delivered as a 0.25 mL intramuscular dose. This vaccine formulation is commonly used for pediatric patients or others for whom the reduced 0.25 mL dose is appropriate. Nationally, seasonal influenza vaccination codes like 90655 are central to public health immunization efforts and routine preventive care delivery across ambulatory settings.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for 90655, the typical administration setting, and common operational considerations connected to billing this immunization. The publication summarizes benchmark topics relevant to payers and providers: coding and billing nuances for intramuscular influenza vaccines, payer coverage patterns and expectations, and how 90655 fits within seasonal vaccine portfolios. It also highlights common modifiers used with immunization services and identifies areas where input data was not provided.
This national overview is intended for revenue cycle managers, immunization program administrators, and clinicians seeking a clear reference on the clinical and billing identity of CPT code 90655, and what to expect when documenting and coding this specific preservative‑free trivalent influenza vaccine.
Billing Code Overview
CPT code 90655 represents a preservative‑free trivalent influenza vaccine formulated with split virus components, supplied in a 0.25 mL dose and administered intramuscularly. The service type is a single‑dose intramuscular influenza immunization for eligible patients requiring a low‑volume pediatric or reduced‑dose preparation. The typical site of service is outpatient clinical settings such as physician offices, clinics, community health centers, and other ambulatory care locations where routine vaccinations are provided. Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 6-month-old infant presents to a primary care pediatric clinic during influenza season for routine vaccination. The child has no history of severe allergic reactions to influenza vaccine components, is up to date on well-child care, and has no current acute febrile illness. The clinical workflow: verification of patient identity and consent, review of immunization record and contraindications, screening questions for recent illnesses and allergies, preparation of the preservative‑free trivalent split-virus influenza vaccine 90655 in a 0.25 mL prefilled syringe, intramuscular administration (typically into the anterolateral thigh for infants), post‑administration observation for 15 minutes, documentation in the electronic medical record and state immunization registry, and billing using 90655. Typical site of service is an outpatient clinic, pediatric office, or community immunization clinic.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (standard reporting) | Use when no special circumstances or modifiers apply. |
| 23 | Unusual anesthesia | Rarely applicable to vaccination; would be used if unexpected anesthesia was required. |