Summary & Overview
CPT 90697: Six‑disease Combination Vaccine, Intramuscular
CPT code 90697 denotes a single intramuscular combination vaccine that protects against six diseases: diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b (Hib), and hepatitis B. As a bundled immunization product, it simplifies administration during routine pediatric and catch-up vaccination visits and can influence inventory, billing workflows, and quality reporting. Nationally, combination vaccines like this matter for improving adherence to recommended schedules and reducing the number of injections per visit.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical and billing context for CPT code 90697, including typical service settings and use cases. The publication summarizes common billing modifiers and payer considerations, provides benchmarks where available, and flags relevant policy or coding updates that affect vaccine administration claims. Clinical context covers indications for combination vaccination and implications for immunization programs. Where input data is missing, the text notes that information is not available.
Billing Code Overview
CPT code 90697 describes a combination vaccine product administered intramuscularly to provide active immunization against six diseases: diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b (Hib), and hepatitis B. The service type is vaccination/immunization, delivered as a single combination dose. The typical site of service is outpatient clinical settings such as physician offices, community clinics, and other ambulatory care locations where intramuscular vaccinations are routinely given.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A healthy infant or toddler presents to a pediatric clinic or community immunization clinic for routine immunization. The clinician reviews the patients immunization record, confirms vaccine indication and age-appropriate schedule, checks for contraindications (e.g., severe allergic reaction to a prior dose or vaccine component), obtains informed consent from the parent or guardian, and documents the lot number, expiration date, and VIS publication date. The combination vaccine represented by 90697 is administered intramuscularly (typically into the anterolateral thigh for infants or the deltoid for older children) using aseptic technique. The patient is observed for a brief post-vaccination period for immediate adverse reactions and provided with vaccine information and follow-up scheduling for subsequent doses if needed. Documentation in the medical record includes the immunization given (90697), route, site, manufacturer, lot number, administration date, and the name of the administering clinician.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier specified | Rarely reported; use when no specific modifier applies |