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CPT 90686: Quadrivalent Influenza Vaccine, Preservative-Free, IM
CPT code 90686 denotes a quadrivalent, preservative-free, split-virus influenza vaccine administered intramuscularly as a 0.5 mL dose. Nationally, influenza vaccination codes like this are central to seasonal public health efforts and routine preventive care, affecting provider workflows, billing practices, and payer coverage policies during influenza seasons. The code specifies the vaccine formulation and route of administration, which can influence clinical choice and billing accuracy.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for this vaccine, typical sites of service where it is administered, and the common billing scenarios associated with intramuscular influenza vaccination. The publication summarizes benchmark considerations, coding nuances relevant to vaccine identification, and potential policy updates that influence coverage and claims processing. It also outlines what to expect in payer interactions and documentation practices for immunization services.
This review is intended for a national audience and focuses on code definition, service context, and payer coverage scope rather than state-specific policies or clinical recommendations. Data not available in the input are noted where applicable in detailed sections.
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Billing Code Overview
CPT code 90686 represents a quadrivalent influenza vaccine, preservative free, split virus, formulated for intramuscular administration as a 0.5 mL dose to protect against four strains of influenza. The product is intended for active immunization against influenza and uses split-virus technology to elicit an immune response.
Service Type
- Vaccine administration (intramuscular)
Typical Site of Service
- Outpatient clinics, physician offices, pharmacies, and community vaccination clinics
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.