Summary & Overview
CPT 90688: Influenza Vaccine, Quadrivalent (Split Virus), 0.5 mL IM
CPT code 90688 represents a quadrivalent, split-virus influenza vaccine supplied as a 0.5 mL dose for intramuscular administration. This code is used to bill for the specific vaccine product that protects against four influenza strains and is part of routine seasonal immunization programs. Nationally, influenza vaccination codes like 90688 matter for public health preparedness, outpatient preventive care metrics, and vaccine supply and reimbursement logistics.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical purpose of the vaccine, typical places where the vaccine is administered, and the common administrative considerations associated with billing this immunization.
The report summarizes benchmarking and coverage practices relevant to vaccine coding and billing, highlights policy considerations that affect vaccine administration in outpatient and ambulatory settings, and provides clinical context about the product type (split virus, quadrivalent, intramuscular, 0.5 mL). Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 90688 describes an influenza vaccine, split virus, quadrivalent, administered as a 0.5 mL intramuscular injection. The service is a vaccine administration intended to provide protection against four influenza virus strains.
Service type: Immunization / Vaccine administration
Typical site of service: Outpatient clinic, physician office, pharmacy-based immunization clinic, or other ambulatory care settings where intramuscular vaccines are routinely given.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to a primary care clinic, occupational health clinic, pharmacy-based immunization center, or employer-sponsored vaccination event during influenza season for routine immunization. The patient is screened for contraindications, consent is obtained, and the clinician documents vaccination history, current health status, and any allergies. The vaccine product represented by 90688 (quadrivalent, split virus, 0.5 mL, intramuscular) is prepared, verified for correct lot and expiration, and administered intramuscularly, typically into the deltoid muscle for adults. Post-vaccination observation of 15 minutes is performed for routine patients and 30 minutes if there is history of severe allergy. Documentation includes vaccine name, CVX code, lot number, expiration date, manufacturer, site and route of administration, dose, and the administering clinician's name and taxonomy. Billing is submitted using 90688 with appropriate modifier(s) as required by payer policy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default / No modifier | Routine submission when no special circumstances apply |