CPT 90658: Trivalent Influenza Vaccine, Split Virus, 0.5 mL

CPT code 90658 denotes a trivalent, split-virus influenza vaccine supplied as a 0.5 mL intramuscular dose. This vaccine code is used broadly across ambulatory and community settings during influenza season and is central to national immunization efforts to reduce influenza morbidity and healthcare utilization. Insurers and public payers reimburse for vaccine products and administration according to policy guidelines and seasonal recommendations, making this code important for providers, payers, and public health planners.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the vaccine, typical sites of service, and the coding specifics tied to product and route of administration. The publication outlines benchmarks and utilization context, summarizes common payer coverage practices, and highlights relevant policy updates that affect vaccine billing and reimbursement nationally. Clinical context explains the vaccine type and route, while billing context clarifies when CPT code 90658 applies. Data not available in the input are identified where applicable.

Billing Code Overview

CPT code 90658 describes a trivalent influenza vaccine, split virus, supplied in a 0.5 mL dose and administered intramuscularly. This service represents the provision of an inactivated influenza vaccine formulated to protect against three influenza strains in a single season.

Service Type: Vaccine administration (intramuscular)

Typical Site of Service: Outpatient clinic, physician office, community health center, or other ambulatory care settings where intramuscular vaccinations are provided.

Clinical Context

A 45-year-old adult presents to an outpatient primary care clinic during influenza season for routine immunization. The patient requests the standard trivalent inactivated influenza vaccine; after screening for contraindications and documenting informed consent, the clinician administers a 0.5 mL intramuscular injection of the trivalent split-virus influenza vaccine represented by CPT 90658. The workflow includes arrival and registration, review of immunization history and allergies, brief screening for acute febrile illness, vaccine education and consent, preparation of the vaccine (drawing into syringe if multi-dose vial or selecting prefilled syringe), intramuscular injection—typically into the deltoid—and documentation of vaccine lot number, expiration date, manufacturer, administration site, and vaccine VIS (Vaccine Information Statement) given. Post‑administration, the patient is observed for a short period for immediate adverse reactions and discharge with aftercare instructions and immunization record update.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of procedure	Use when a separate E/M visit is performed on same day as vaccine administration and meets E/M documentation requirements

Taxonomy Code	Specialty	Notes
`208000000X`	Family Medicine	Primary care clinicians commonly administer routine influenza vaccines
`207Q00000X`	Internal Medicine	Adult primary care providers administer seasonal influenza vaccines
`3336C0004X`	Preventive Medicine	Preventive medicine specialists and public health clinics provide immunizations
`208000000X`	Nurse Practitioner	Advanced practice providers who routinely give vaccines (same taxonomy code used for NP practice settings)
`364S00000X`	Nursing — Registered Nurse	Registered nurses frequently perform vaccine administration under standing orders

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z23`	Encounter for immunization	Primary encounter code used when administering routine influenza vaccination, documents purpose of visit
`J00`	Acute nasopharyngitis [common cold]	Screening for acute febrile illness; if present, provider may defer vaccination and document reason
`J02.9`	Acute pharyngitis, unspecified	Acute infection may be reason to defer immunization or document separate E/M service if assessed
`Z51.11`	Encounter for antineoplastic chemotherapy	Example of comorbidity where influenza vaccination is often recommended and documented alongside cancer care
`Z79.899`	Other long term (current) drug therapy	Chronic therapy (e.g., immunosuppressants) is relevant to vaccination decisions and documentation

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 vaccine/toxoid component	Not applicable by age for `90658` but paired CPT administration codes exist for documenting vaccine administration services when counseling is provided; for adults use `90471`/`90472`
`90471`	Immunization administration (intramuscular, single or first component)	Commonly reported alongside vaccine product code `90658` to document intramuscular administration when no counseling or when minimal counseling occurs
`90472`	Immunization administration, each additional component (same date)	Use if multiple vaccines/components administered in same encounter in addition to `90471`
`99500`	Home visit for immunization administration	Used when influenza vaccine is administered in the patient's home setting rather than clinic
`90656`	Influenza virus vaccine, trivalent, preservative-free, split virus, for intramuscular use, 0.5 mL dosage	Related influenza vaccine product code; alternative trivalent formulation that may be selected based on product availability

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Summary & Overview