Summary & Overview
CPT 90696: Combination DTaP-IPV Vaccine for Children 4–6 Years
CPT code 90696 denotes an intramuscular combination vaccine for children aged 4 to 6 years that protects against diphtheria, tetanus, pertussis, and poliovirus. As a routine pediatric immunization, this vaccine plays a key role in maintaining population immunity, preventing outbreaks of vaccine-preventable diseases, and supporting pediatric preventive care delivery.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The code is relevant across public and private payers that cover pediatric immunizations, with implications for vaccine coverage policies, billing workflows, and provider reimbursement for routine childhood immunization services.
Readers will learn the clinical context for the code, typical service settings where the vaccine is administered, and which major payers are commonly involved in covering the service. The publication also summarizes common billing modifiers and notes when input data elements were not provided. Data not available in the input is explicitly noted where applicable. This national-level overview is intended to clarify coding, payer coverage scope, and clinical purpose of CPT code 90696 for health care administrators, coders, and policy stakeholders.
Billing Code Overview
CPT code 90696 represents a combination intramuscular vaccine formulated to protect children aged 4 to 6 years against diphtheria, tetanus, pertussis (whooping cough), and poliovirus. This product is a pediatric combination immunization intended for routine childhood vaccination schedules.
Service Type: Vaccine administration (combination pediatric immunization)
Typical Site of Service: Outpatient clinic, pediatrician's office, community health center, or public health clinic
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 5-year-old child presents to a pediatric primary care clinic for routine immunizations per the childhood immunization schedule. The child is medically well, accompanied by a parent, and has no contraindications to inactivated vaccines. After review of the immunization record and parental consent, the clinician administers the intramuscular combination vaccine protecting against diphtheria, tetanus, pertussis, and inactivated poliovirus using 90696. The visit workflow includes vaccine screening for allergies and acute illnesses, documentation of lot number and site, observation for immediate adverse reactions for 15 minutes, updating the immunization registry, and billing the vaccine using the appropriate CPT code with a vaccine administration code and any applicable modifier indicating payment/coverage status or special circumstances.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier specified | Rarely used; present as a general placeholder when no specific modifier applies |
11 | Special payment proviso |