CPT 90679: Prefusion F (preF) RSV Vaccine, Adjuvanted, Intramuscular - OpenPayer

Summary & Overview

CPT 90679: Prefusion F (preF) RSV Vaccine, Adjuvanted, Intramuscular

CPT code 90679 denotes a prefusion F (preF) respiratory syncytial virus (RSV) vaccine product that includes an adjuvant and is administered intramuscularly. As an immunization code for a novel RSV vaccine formulation, it matters nationally because RSV is a major cause of respiratory illness across age groups, and adjuvanted prefusion F vaccines aim to improve immune protection and durability. Adoption and coverage decisions for this vaccine influence preventive care delivery, immunization program budgets, and clinician workflows.

Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage considerations, common billing modifiers, and expected sites of service for administration.

Readers will learn the clinical context of the vaccine, the service type and typical settings for administration, and where to find payer-specific coverage and billing guidance. The report also summarizes benchmarking and policy touchpoints relevant to national immunization programs and reimbursement pathways. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare90679CPTRSV vaccineprefusion Fadjuvanted vaccineimmunizationintramuscularpreventive carevaccine billing

Billing Code Overview

CPT code 90679 represents a prefusion F (preF) respiratory syncytial virus (RSV) vaccine formulated with an adjuvant and administered intramuscularly. The code indicates a vaccine product designed to generate a stronger immune response through the inclusion of an adjuvant.

Service Type: Vaccination / Immunization (intramuscular)

Typical Site of Service: Office, clinic, or other outpatient vaccination settings

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with chronic obstructive pulmonary disease (COPD) and a history of recurrent lower respiratory infections presents to a primary care clinic in the fall for preventive immunization against respiratory syncytial virus (RSV). The clinician reviews medical history, confirms no contraindications to vaccination (e.g., severe allergic reaction to prior RSV vaccines or vaccine components), obtains informed consent, documents current medications and allergies, and performs a brief targeted exam. The vaccine product represented by 90679 (a prefusion F (preF) RSV vaccine with adjuvant) is administered intramuscularly, typically into the deltoid. Post-vaccination observation for 15–30 minutes occurs to monitor for immediate adverse reactions. Documentation includes vaccine lot number, manufacturer, administration site, route, dose, and vaccine-specific VIS (vaccine information statement) given. Billing is submitted by the administering provider using 90679 and appropriate modifier(s) if applicable, with immunization administration codes or office visit codes billed per payer policies.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)	Use when no special circumstance applies to the vaccine administration.

CPT 90747: Hepatitis B Vaccine for Immunosuppressed or Dialysis Patients

cpt-90734-meningococcal-conjugate-vaccine-menacwy-administration

CPT 90734: Meningococcal Conjugate Vaccine (MenACWY) Administration

cpt-90759-hepatitis-b-three-antigen-vaccine-10mcg-3-dose

CPT 90759: Hepatitis B Three‑Antigen Vaccine, 10 mcg, Three‑Dose

cpt-90738-japanese-encephalitis-vaccine-im-injection

CPT 90738: Inactivated Japanese Encephalitis Vaccine, IM

cpt-90667-influenza-vaccine-split-virus-adjuvanted-im-admin

CPT 90667: Split-Virus Adjuvanted Influenza Vaccine, Intramuscular

cpt-90750-adjuvanted-varicella-zoster-vaccine-im-injection

CPT 90750: Adjuvanted Varicella Zoster Vaccine, Intramuscular Injection

cpt-90621-meningococcal-recombinant-lipoprotein-vaccine-im

CPT 90621: Meningococcal Recombinant Lipoprotein Vaccine, IM

cpt-90632-adult-hepatitis-a-vaccine-immunization

CPT 90632: Adult Hepatitis A Vaccine, Intramuscular

cpt-90715-tdap-booster-vaccination-age-7-plus

CPT 90715: Tdap Booster Vaccination for Age 7 and Older

cpt-90657-trivalent-influenza-vaccine-split-virus-025ml-im-im

CPT 90657: Trivalent Influenza Vaccine, Split Virus, 0.25 mL IM

Showing 1–10 of 101

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians who commonly assess and administer adult vaccines.
`207R00000X`	Internal Medicine	Adult medicine physicians who provide preventive immunizations to older adults.
`282N00000X`	Physician Assistant	Clinicians who frequently administer vaccinations in outpatient settings.
`163W00000X`	Nurse Practitioner	Advanced practice nurses who provide immunizations and document vaccine administration.
`364S00000X`	Public Health Nursing	Nurses working in public health clinics and mass immunization campaigns.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J44.9`	Chronic obstructive pulmonary disease, unspecified	COPD patients are at increased risk of severe RSV and are appropriate candidates for RSV vaccination.
`J18.9`	Pneumonia, unspecified organism	History of lower respiratory tract infections or pneumonia supports preventive vaccination to reduce recurrent severe RSV-related illness.
`I10`	Essential (primary) hypertension	Common comorbidity in older adults receiving routine vaccines; relevant for overall risk stratification.
`E78.5`	Hyperlipidemia, unspecified	Common chronic condition in older adults; included to capture routine comorbidity coding in preventive visits.
`Z23`	Encounter for immunization	Primary encounter code used to indicate the visit is for administration of vaccine `90679`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90460`	Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered	Related when counseling occurs as part of combined administration services; note age limitation — not typical for older adults.
`90461`	Immunization administration through 18 years of age; each additional vaccine/toxoid	Related for multiple pediatric vaccine administrations; not commonly paired with `90679` which is an adult RSV vaccine.
`90471`	Immunization administration (intramuscular, single or first vaccine/toxoid component)	Commonly used when billing the administration of an intramuscular vaccine for adults in some payer systems instead of bundled immunization codes.
`90472`	Immunization administration, each additional vaccine/toxoid (intramuscular)	Used when multiple injectable vaccines are given at the same visit alongside `90679`.
`99212`	Office or other outpatient visit for the evaluation and management of an established patient, typically 10 minutes	May be billed when a separate E/M visit is provided the same day with documentation supporting medical necessity and modifier usage per payer rules.
`99070`	Supplies and materials (e.g., bandages, syringes) provided by the physician over and above those usually included with the office visit or procedure	May be used when billing for additional supplies associated with vaccine administration if payer permits.

OpenPayer