Summary & Overview
CPT 90678: Bivalent Prefusion F RSV Vaccine, Intramuscular
CPT code 90678 denotes a bivalent prefusion F respiratory syncytial virus (RSV) vaccine administered intramuscularly. As RSV prevention advances with targeted vaccine formulations, this code enables standardized reporting of administration of a modern bivalent prefusion F vaccine product. Nationally, precise coding supports public health vaccination efforts, surveillance, and payer processing for routine and campaign immunization programs.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of coverage and billing implications across major payers, typical sites of service where this vaccine is delivered, and relevant clinical context about the vaccine modality. The publication also summarizes common modifiers and coding considerations where available and flags items for which input data were not provided.
This report is useful for billing staff, practice managers, and policy analysts seeking a clear reference for filing and administrative tracking of intramuscular RSV bivalent prefusion F vaccine services. Content focuses on code definition, clinical administration context, payer landscape, and what to expect in claims processing at a national level.
Billing Code Overview
CPT code 90678 represents a bivalent prefusion F respiratory syncytial virus (RSV) vaccine product administered intramuscularly. The code describes the vaccine formulation and the route of administration used to protect eligible individuals against RSV.
Service Type: Vaccine administration (intramuscular)
Typical Site of Service: Clinic, physician office, outpatient vaccination clinic, or other ambulatory care setting
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old adult with chronic obstructive pulmonary disease presents to an outpatient primary care clinic during RSV season for immunization. The clinician confirms immunization history, screens for contraindications (eg, severe allergic reaction to vaccine components), obtains informed consent, documents lot number and expiration, and administers a single intramuscular dose of the bivalent prefusion F respiratory syncytial virus vaccine (90678) in the deltoid. The vaccine is supplied from clinic inventory; the nurse monitors the patient for 15 minutes for immediate adverse reactions. Documentation includes vaccine brand and NDC, administration site, route, dose, lot number, expiration date, the vaccine billing code 90678, and any applicable modifier(s). If the patient has an adverse event requiring emergency transfer, additional facility, transport, and evaluation codes may be appended.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Service or procedure furnished as a defined by payer; often placeholder for standard reporting | Use when no other modifier applies and payer requires a two-character modifier field populated with default |