Summary & Overview
CPT 90667: Split-Virus Adjuvanted Influenza Vaccine, Intramuscular
CPT code 90667 denotes an intramuscular, split-virus influenza vaccine containing an adjuvant formulated to protect against a pandemic influenza strain. As a preventive vaccine product, it is relevant to national immunization efforts, pandemic preparedness, and payer coverage policies. The code identifies the vaccine product itself rather than administration-only services; its use signals delivery of a specific antigen/adjuvant formulation intended to enhance immune response for population-level protection.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on clinical purpose and typical service settings, plus what to expect in payer coverage discussions. The publication provides benchmarks and policy-related considerations relevant to coding, reimbursement pathways, and vaccine administration workflows, and highlights clinical context for an adjuvanted, split-virus intramuscular pandemic influenza vaccine.
This national-level summary is intended for billing managers, clinicians involved in immunization programs, and policy analysts who need concise information about the product-level CPT code, typical sites of service, payer landscape, and the types of operational and policy implications that accompany use of a pandemic influenza vaccine coded with 90667.
Billing Code Overview
CPT code 90667 represents an influenza vaccine product formulated as a split virus and containing an adjuvant, administered intramuscularly to protect against a pandemic influenza strain. The service is a preventive immunization intended to induce or enhance immune protection against the specified pandemic flu antigen.
Service Type: Vaccine administration (preventive immunization)
Typical Site of Service: Outpatient clinics, primary care offices, public health vaccination sites, and pharmacies where intramuscular vaccines are provided
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient presents to a primary care clinic during a declared pandemic influenza season to receive an intramuscular, adjuvanted, split-virus influenza vaccine intended specifically for the pandemic strain. The clinic check-in confirms payer information (Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, Medicare) and documents allergies and prior adverse vaccine reactions. A licensed nurse verifies indication, obtains informed consent, confirms appropriate storage and lot number, and performs an intramuscular injection (typically deltoid) using standard aseptic technique. Post-vaccination, the patient is observed for 15 minutes for immediate reactions and wound/administration documentation (vaccine type 90667, manufacturer, lot, expiration, site, route) is entered into the electronic health record and the state immunization registry. If the patient has a contraindication or receives a reduced service (e.g., partial dose), the appropriate modifier is appended on the claim. Typical sites of service include outpatient clinic, physician office, community vaccination clinic, and public health clinic.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier / state-defined default | Use as the primary claim without special circumstances when no other modifier applies |