Summary & Overview
CPT 90657: Trivalent Influenza Vaccine, Split Virus, 0.25 mL IM
CPT code 90657 designates a trivalent influenza vaccine product containing split virus components, supplied for intramuscular administration in a 0.25 mL dose. As an immunization product code, it is used on claims to identify this specific vaccine formulation and dose. Influenza vaccination codes like 90657 are central to national immunization efforts, public health reporting, and payer coverage policies during seasonal influenza campaigns.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise presentation of clinical context for the vaccine, typical sites of service where 90657 is billed, common billing modifiers associated with immunization services, and where available, payer coverage considerations. The publication also outlines the kinds of benchmarks and policy details typically examined for vaccine product codes, such as reimbursement patterns, site-of-service implications, and billing best practices.
This summary is intended for national audiences including billing managers, revenue cycle staff, compliance officers, and clinical program administrators who need a clear reference for the product-level code, its clinical use, and the payer landscape that affects claims processing and coverage decisions. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 90657 represents a trivalent influenza vaccine, split virus, formulated for intramuscular administration in a 0.25 mL dose. This code denotes the vaccine product itself and the specific formulation and dosage.
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Service type: Immunization administration of a trivalent influenza vaccine product (split virus)
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Typical site of service: Outpatient clinics, physician offices, pharmacies, community vaccination centers, and other ambulatory care settings where intramuscular vaccines are provided
Clinical & Coding Specifications
Clinical Context
A 6-month-old infant presents to a primary care pediatric clinic during influenza season for routine immunizations. The nurse verifies the patient’s immunization record, documents any vaccine allergies, and performs a brief screening for acute illness. After parental consent, the clinician administers a 0.25 mL intramuscular injection of the trivalent split-virus influenza vaccine (90657) into the anterolateral thigh. The patient is observed for 15 minutes for immediate adverse reactions. Documentation includes vaccine lot number, expiration date, site and route of administration, VIS edition and date, and the name and title of the administrator. The encounter is billed under the office outpatient visit or immunization-only visit depending on whether other services were provided.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | General claim submission when no modifier applies |
22 | Increased procedural services | Rarely used for vaccines; when additional work beyond typical vaccine administration is documented |