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    v1.0.28
    OpenPayerBilling CodesVaccines, ToxoidsCPT cpt-90685-quadrivalent-flu-vaccine-0-25ml-im-injection
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    CPT 90685: Quadrivalent Intramuscular Influenza Vaccine, 0.25 mL

    CPT code 90685 describes a quadrivalent, split-virus, preservative-free influenza vaccine administered by intramuscular injection as a 0.25 mL dose; this service is a vaccine administration typically provided in outpatient clinics, physician offices, public health clinics, and other ambulatory care settings for active immunization against seasonal influenza.

    For related coverage guidance, see recent payer policy updates: B-Hemolytic Streptococcus Testing, Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance Assays, Hepatitis Testing (A, B, C, D) Coverage Criteria.

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    Table of contents

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    • Billing CodesCPT, HCPCS, DRG & more
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    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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    90460Immunization administration through 18 years of age via any route, with counseling by physician or other qualified health care professional; first or only component of each vaccine/toxoid administeredUsed when counseling and administration for patients ≤18 are billed separately under payer rules; often paired when counseling time is significant.
    90461Each additional vaccine/toxoid administered to patients ≤18 yearsBilled for each additional vaccine given at the same encounter when payer requires separate administration codes.
    90471Immunization administration (any route) first vaccine (single or combination vaccine/toxoid)Adult/adolescent administration code used by many payers instead of age-based codes for single vaccine administration.
    90472Each additional vaccine (single or combination vaccine/toxoid) administered (same date)Used when multiple vaccines are administered in the same visit for adults/adolescents.
    90658Influenza virus vaccine, trivalent, split virus, preservative free, 0.25 mL doseRelated influenza vaccine code representing a trivalent formulation; useful for payer cross-referencing and inventory documentation.
    90686Influenza virus vaccine, quadrivalent, split virus, preservative free, 0.5 mL doseRelated quadrivalent vaccine for older age groups; used in workflow when dosing differs by patient age.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207Q00000XFamily Medicine PhysicianFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
    207R00000XInternal Medicine PhysicianA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
    363A00000XPhysician AssistantA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    163WN0002XNeonatal Intensive Care Registered NurseNursing Service Providers · Registered Nurse
    1744R1103XResearch Study Abstracter/CoderOther Service Providers · Specialist
    207QS0010XSports Medicine (Family Medicine) PhysicianA family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of hea…
    310400000XAssisted Living FacilityA facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitorin…

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    D64.9Anemia, unspecified
    E11.9Type 2 diabetes mellitus without complications
    I10Essential (primary) hypertension
    J00Acute nasopharyngitis [common cold]
    J06.9Acute upper respiratory infection, unspecified
    J09.X2Influenza due to identified novel influenza A virus with other respiratory manifestations
    J10.1Influenza due to other identified influenza virus with other respiratory manifestations
    J11.1Influenza due to unidentified influenza virus with other respiratory manifestations
    J18.9Pneumonia, unspecified organism
    J20.9Acute bronchitis, unspecified

    Showing 1–10 of 27

    Related Payer Policy Updates

    Specialty: Infectious Disease1 / 3

    10 rows

    PolicyPayerEffective Date
    B-Hemolytic Streptococcus TestingOscar Health2026-10-01
    Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance AssaysOscar Health2026-10-01
    Hepatitis Testing (A, B, C, D) Coverage CriteriaOscar Health2026-10-01
    Lyme Disease Testing Coverage CriteriaOscar Health2026-10-01
    Pathogen Panel TestingOscar Health2026-10-01
    Diagnostic Testing of Common Sexually Transmitted InfectionsOscar Health2026-10-01
    Testing for Diagnosis of Active or Latent TuberculosisOscar Health2026-10-01
    Testing for Vector-Borne InfectionsOscar Health2026-10-01
    Coronavirus Testing in the Outpatient SettingOscar Health2026-10-01
    Human Immunodeficiency Virus (HIV)blue cross blue shield - louisiana2026-09-15

    Related Codes

    CPT-90476-ADENOVIRUS-TYPE-4-ORAL-VACCINE-ADMINISTRATION

    CPT 90476: Oral Live Vaccine for Adenovirus Type 4

    CPT-90477-ORAL-LIVE-ADENOVIRUS-TYPE-7-VACCINE

    CPT 90477: Oral Live Adenovirus Type 7 Vaccine Administration

    CPT-90581-ANTHRAX-VACCINE-INJECTION

    CPT 90581: Anthrax Vaccine, Injection

    CPT-90584-QUADRIVALENT-LIVE-DENGUE-VACCINE-SUBCUTANEOUS

    CPT 90584: Quadrivalent Live Dengue Vaccine, Subcutaneous, Two-Dose

    CPT-90585-TB-LIVE-INTRADERMAL-VACCINE

    CPT 90585: Live Tuberculosis Vaccine Administered Through the Skin

    CPT-90586-INTRAVESICAL-LIVE-VACCINE-BLADDER-CANCER

    CPT 90586: Intravesical Live Vaccine for Bladder Cancer

    CPT-90587-DENGUE-VACCINE-SUBCUTANEOUS-THREE-DOSE

    CPT 90587: Quadrivalent Live Dengue Vaccine, Subcutaneous, Three-Dose

    CPT-90589-CHIKUNGUNYA-VACCINE-INTRAMUSCULAR-LIVE-ATTENUATED

    CPT 90589: Chikungunya Vaccine, Live Attenuated, Intramuscular

    CPT-90593-RECOMBINANT-CHIKUNGUNYA-VACCINE-INTRAMUSCULAR

    CPT 90593: Recombinant Chikungunya Vaccine, Intramuscular

    CPT-90611-SMALLPOX-MONKEYPOX-VACCINE-SUBCUTANEOUS-05ML

    CPT 90611: Combined Smallpox and Monkeypox Vaccine, Subcutaneous 0.5 mL

    Showing 1–10 of 101

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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