CPT 90698: Combination DTaP-Hib-IPV Vaccine, Intramuscular - OpenPayer

Summary & Overview

CPT 90698: Combination DTaP-Hib-IPV Vaccine, Intramuscular

CPT code 90698 covers a five-antigen combination vaccine administered intramuscularly to protect against diphtheria, tetanus, pertussis, Haemophilus influenzae type b (Hib), and polio. As a single-product option for pediatric and catch-up immunization schedules, this vaccine can simplify clinical workflows, reduce the number of injections, and support adherence to routine immunization recommendations. Nationally, combination vaccines are relevant to public health initiatives and payer vaccination policies because they affect vaccination rates, billing practices, and inventory management.

Key payers addressed in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service settings, common billing modifiers and administrative considerations, typical sites of service, and where available, payer coverage patterns. The publication also summarizes related policy implications for vaccination coding and billing, outlines typical billing modifiers used with immunization services, and identifies areas where input data were not provided. This resource is intended for billing professionals, clinic administrators, and policy analysts seeking a national-level briefing on the coding, administrative context, and payer landscape for CPT code 90698.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 90698combination vaccineimmunizationvaccine administrationpediatricsambulatory careintramuscular injectionpreventive carebilling and coding

Billing Code Overview

CPT code 90698 represents a combination intramuscular vaccine designed to protect against five diseases: diphtheria, tetanus, pertussis, Haemophilus influenzae type b (Hib), and polio. This multi-antigen vaccine is administered as an intramuscular injection to provide combined immunization coverage in a single product.

Service Type: Vaccine administration (combination immunization)

Typical Site of Service: Outpatient clinics, physician offices, community vaccination centers, and other ambulatory care settings where intramuscular vaccines are given

Clinical & Coding Specifications

Clinical Context

A healthy pediatric patient presents to a primary care clinic for routine immunizations. The clinician administers the combination intramuscular vaccine that protects against diphtheria, tetanus, pertussis, Haemophilus influenzae type b (Hib), and poliovirus using CPT 90698. The workflow includes patient identification and consent, review of immunization history and contraindications, preparation of the vaccine per manufacturer instructions, intramuscular injection (typically deltoid for older children/adolescents or anterolateral thigh for infants), documentation of lot number, manufacturer, administration site, and vaccine VIS date in the medical record and immunization registry, and billing with the appropriate payer information and any applicable modifier (for example, 25 if a significant, separately identifiable E/M visit occurred the same day). The visit may occur at an outpatient clinic, pediatrician office, community health center, or public health immunization clinic. Typical payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare depending on patient age and coverage.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure

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CPT 90690: Oral Live Vaccine for Typhoid Fever

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Taxonomy Code	Specialty	Notes
`207Q00000X`	Pediatrics	Primary specialty that administers routine childhood combination vaccines.
`207R00000X`	Family Medicine	Commonly provides immunizations for children and adults.
`208000000X`	Internal Medicine	May administer this vaccine for catch-up immunizations in older patients.
`335100000X`	Public Health	Clinics and immunization programs that provide routine vaccines.
`363L00000X`	Nurse Practitioner	Frequently administers vaccines in outpatient settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z23`	Encounter for immunization	Primary administrative diagnosis used when administering routine vaccines such as `CPT 90698`.
`Z00.129`	Encounter for routine child health examination without abnormal findings	Used when vaccine is given during a well-child visit.
`Z00.121`	Encounter for routine child health examination with abnormal findings	Used when vaccine is administered during a visit with findings requiring attention.
`R50.9`	Fever, unspecified	May be a presenting symptom prompting evaluation; vaccination status is often reviewed during acute visits but recent fever can influence vaccine timing.
`Z71.89`	Other specified counseling	Used when vaccine counseling is a focus of the visit in addition to administration.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90460`	Immunization administration through 18 years of age via any route of administration; with counseling by physician or other qualified health care professional, first component of each vaccine or toxoid administered	Used when counseling is provided during vaccine administration for patients under 19 and when reporting vaccine administration with counseling on the same day.
`90461`	Immunization administration through 18 years of age; each additional vaccine or toxoid (list separately in addition to code for primary procedure)	Used to report additional vaccines given at the same visit in pediatric patients when reporting per-dose administration codes.
`90471`	Immunization administration (intramuscular, single vaccine)	Alternative administration code for a single IM vaccine in patients of any age when per-dose administration codes are required.
`90696`	Diphtheria, tetanus toxoids, and acellular pertussis vaccine, may include Hib and polio components — combination vaccine (alternative combination formulations)	Related vaccine product codes that may be used when a different formulation or product is administered.
`90700`	Diphtheria and tetanus toxoids adsorbed; pediatric-type	May be used for monovalent or different combination immunization in the immunization schedule.

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