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A quadrivalent influenza virus vaccine, specifically identified as CPT® Code 90686, is a split virus formulation that is preservative-free and intended for intramuscular administration. This vaccine is designed to provide active, long-term immunity against influenza by introducing altered versions of the virus into the recipient's immune system. Unlike immune globulins, which offer short-term, passive immunity, vaccines stimulate the immune system to produce its own antibodies, thereby preparing the body to respond effectively to future exposures to the virus. The preservative-free aspect of this vaccine indicates that it does not contain the preservative thimerosal, or contains only trace amounts, and is recognized by the FDA as either thimerosal-free or thimerosal-reduced. The vaccine is delivered via an intramuscular injection, which is a separate procedure that must be reported independently. The production of this influenza vaccine involves the use of embryonated chicken eggs, where the virus is harvested, inactivated with formaldehyde, concentrated, purified, and chemically disrupted to create a split virus. This specific formulation protects against four strains of influenza viruses, including two type A strains and two type B strains, ensuring a broad spectrum of immunity. For reporting purposes, CPT® Code 90685 is used for a 0.25 mL dosage of the vaccine, while CPT® Code 90686 is designated for the 0.5 mL dosage, with both codes solely representing the vaccine product itself.
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The quadrivalent influenza virus vaccine (CPT® Code 90686) is indicated for the prevention of influenza caused by the four specific strains of the virus included in its formulation. The vaccine is recommended for individuals who are at risk of contracting influenza, particularly during the flu season. The following conditions and populations may warrant the administration of this vaccine:
The administration of the quadrivalent influenza virus vaccine involves several key procedural steps to ensure proper delivery and effectiveness:
Following the administration of the quadrivalent influenza virus vaccine, patients may experience mild side effects, such as soreness at the injection site, low-grade fever, or fatigue. These symptoms typically resolve within a few days. It is important for patients to be informed about these potential reactions and to understand that they are generally mild compared to the complications associated with influenza itself. Patients should also be advised to seek medical attention if they experience any severe or unusual symptoms following vaccination. Additionally, documentation of the vaccine administration, including the date, dosage, and site of injection, should be recorded in the patient's medical record for future reference and compliance with vaccination guidelines.
| Short Descr | IIV4 VACC NO PRSV 0.5 ML IM | Medium Descr | IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE | Long Descr | Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use | Related Drugs | Afluria Quadrivalent | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Influenza, Pneumococcal Pneumonia, Hepatitis B, and Covid-19 Vaccines; Monoclonal Antibody Therapy Product | ASC Payment Indicator | Influenza vaccine; pneumococcal vaccine. | Type of Service (TOS) | V - Pneumococcal/Flu Vaccine | Berenson-Eggers TOS (BETOS) | O1G - Immunizations/Vaccinations | MUE | 1 | CCS Clinical Classification | 228 - Prophylactic vaccinations and inoculations |
| GA | Waiver of liability statement issued as required by payer policy, individual case | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | JZ | Zero drug amount discarded/not administered to any patient | GC | This service has been performed in part by a resident under the direction of a teaching physician | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care | GW | Service not related to the hospice patient's terminal condition | SL | State supplied vaccine | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CR | Catastrophe/disaster related | U1 | Medicaid level of care 1, as defined by each state | LT | Left side (used to identify procedures performed on the left side of the body) | UC | Medicaid level of care 12, as defined by each state | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | KX | Requirements specified in the medical policy have been met | FA | Left hand, thumb | GZ | Item or service expected to be denied as not reasonable and necessary | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | TB | Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | 99 | Multiple modifiers: under certain circumstances 2 or more modifiers may be necessary to completely delineate a service. in such situations modifier 99 should be added to the basic procedure, and other applicable modifiers may be listed as part of the description of the service. | FS | Split (or shared) evaluation and management visit | GT | Via interactive audio and video telecommunication systems | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GX | Notice of liability issued, voluntary under payer policy | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) | RT | Right side (used to identify procedures performed on the right side of the body) | SA | Nurse practitioner rendering service in collaboration with a physician | SK | Member of high risk population (use only with codes for immunization) | SY | Persons who are in close contact with member of high-risk population (use only with codes for immunization) | TJ | Program group, child and/or adolescent | U7 | Medicaid level of care 7, as defined by each state | UD | Medicaid level of care 13, as defined by each state | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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Notes
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| 2017-01-01 | Changed | Long, Medium and Short descriptions changed. |
| 2016-01-01 | Changed | First appearance in codebook. |
| 2015-07-01 | Changed | Description Changed |
| 2014-01-01 | Added | First appearance in codebook. |
| 2013-01-01 | Added | Code Added |
| 2012-12-14 | Changed | Approved by FDA. Removed the 'Product Pending FDA Approval' flag. |
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