Summary & Overview
CPT 90685: Quadrivalent Influenza Vaccine, 0.25 mL IM Dose
CPT code 90685 denotes a quadrivalent, split–virus influenza vaccine given by intramuscular injection in a 0.25 mL preservative‑free dose. As an influenza immunization option for eligible patients, this code is used widely in outpatient clinics, physician offices, pharmacy vaccination clinics, and other primary care settings. Nationally, seasonal influenza vaccination plays a key role in preventive care, reducing influenza-related morbidity and healthcare utilization.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the vaccine, common billing considerations, and payer coverage patterns where available. The publication summarizes typical service settings and outlines the performance measures and billing elements that influence claim processing for this vaccine.
This report provides benchmarks and policy context relevant to immunization services, clarifies the clinical scenario associated with 90685, and highlights areas where billing clarity matters for providers and billing staff. Data not available in the input is noted where applicable; the focus remains on what 90685 represents clinically and operationally for national stakeholders.
Billing Code Overview
CPT code 90685 represents a quadrivalent influenza (flu) vaccine, administered by intramuscular injection. The vaccine is a split–virus, preservative–free formulation provided in a 0.25 mL dose.
Service Type: Vaccination / Immunization
Typical Site of Service: Clinic, physician office, outpatient vaccination clinic, or pharmacy setting where intramuscular injections are provided.
Clinical & Coding Specifications
Clinical Context
A healthy pediatric patient aged 6 months presents to a primary care clinic during influenza season for routine immunization. The clinician confirms vaccine history and checks for contraindications (egg allergy status, previous severe reactions). The patient receives a 0.25 mL intramuscular injection of a split-virus, preservative-free quadrivalent influenza vaccine (90685) administered into the deltoid (or anterolateral thigh for infants). Site staff document lot number, manufacturer, administration route, dose, and VIS date; observe the patient for 15 minutes for adverse reactions; and update the immunization record and state immunization registry. Billing is submitted with the vaccine code 90685 and appropriate ICD-10 diagnosis code(s) reflecting immunization encounter or patient risk status, with modifier(s) applied as needed for payer adjudication.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/Specialty unmodified | Used when no other modifier applies; many payers expect a two-character default. |
11 |