CPT 90686: Quadrivalent Influenza Vaccine, Split-Virus, Preservative-Free
Commercial payers pay $23 on average nationally for this procedure.
CPT code 90686 describes a preservative-free, split-virus quadrivalent influenza vaccine formulated for intramuscular administration as a 0.5 mL dose to protect against four influenza virus strains; service type is vaccine administration (intramuscular) and the typical site of service is an outpatient clinic, physician office, or pharmacy immunization setting.
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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National Reimbursement Benchmarks
National commercial reimbursement for CPT 90686 clusters around BUCA’s average commercial rate of $22.8, which serves as a useful center point for comparison. UnitedHealth Group posts the highest median and mean levels near $25.0 and $25.7, while Cigna and Blue Cross Blue Shield sit close to BUCA with medians around $22.1 and $21.9 respectively; Aetna’s mean of $22.3 also aligns with this midrange. Cigna shows the highest single maximum at $67.0 and Aetna and UnitedHealth Group display notable upper extremes of $56.1 and $44.1.
Dispersion measured by the interquartile range (P75–P25) is tightest for Cigna at $0.0 (P75 $22.1 minus P25 $22.1) and quite narrow for Blue Cross Blue Shield at $2.6 (P75 $24.7 minus P25 $20.1). UnitedHealth Group has a moderate IQR of $4.4 (P75 $26.8 minus P25 $22.4), while BUCA’s IQR is $4.4 (P75 $25.1 minus P25 $20.7). Aetna’s IQR is $8.0 (P75 $28.0 minus P25 $20.0), indicating the widest midrange spread among these payers.