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The CPT® Code 90694 refers to the quadrivalent influenza virus vaccine, specifically the adjuvanted inactivated influenza vaccine (aIIV4). This vaccine is designed for intramuscular use and is preservative-free, with a dosage of 0.5 mL. The term "quadrivalent" indicates that this vaccine is formulated to protect against four different strains of the influenza virus, which includes two distinct strains of influenza type A and two strains of type B. The vaccine is produced using embryonated chicken eggs, where the influenza virus is cultivated, harvested, and subsequently inactivated through the use of formaldehyde. The aIIV4 vaccine is classified as a subunit vaccine, meaning it contains only the specific antigens that are most effective in eliciting an immune response. The process of creating a subunit vaccine involves the identification and isolation of these essential antigens, which can be achieved through laboratory cultivation of the virus and the application of chemical methods to separate the antigens, or through recombinant DNA technology. To enhance the immune response, an adjuvant is incorporated into the vaccine formulation. In this case, the adjuvant used is MF59, which is an oil-in-water emulsion. The presence of MF59 aids in increasing the uptake of the antigen and promotes better binding of antibodies to the influenza virus. Additionally, it facilitates the recruitment of macrophages and enhances the migration of immune cells to lymph nodes, thereby improving the overall immune response. Research indicates that this adjuvanted vaccine may offer superior protection for children aged 6 to 23 months compared to non-adjuvanted vaccines. It is important to note that this code specifically pertains to the supply of the vaccine itself, while the administration of the vaccine via intramuscular injection is reported separately.
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The aIIV4 influenza vaccine (CPT® Code 90694) is indicated for the prevention of influenza in individuals, particularly in populations that may benefit from enhanced immune responses. The following conditions and circumstances warrant the administration of this vaccine:
The administration of the aIIV4 influenza vaccine involves several key procedural steps to ensure proper delivery and effectiveness of the vaccine:
Following the administration of the aIIV4 influenza vaccine, patients are typically advised to remain in the healthcare setting for a brief observation period, usually around 15 minutes, to monitor for any immediate allergic reactions. Common post-vaccination care includes advising the patient to apply a cool compress to the injection site if they experience soreness or swelling. Patients should also be informed about potential mild side effects, such as low-grade fever, fatigue, or localized pain at the injection site, which usually resolve within a few days. It is important for patients to be educated on the signs of more serious adverse reactions, such as difficulty breathing or swelling of the face and throat, and to seek immediate medical attention if these occur. Additionally, patients should be encouraged to maintain their vaccination schedule and return for any follow-up doses as recommended.
| Short Descr | VACC AIIV4 NO PRSRV 0.5ML IM | Medium Descr | AIIV4 VACC INACTIVATED PRSRV FR 0.5ML DOS IM USE | Long Descr | Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use | Related Drugs | FLUAD 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) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| GW | Service not related to the hospice patient's terminal condition | JZ | Zero drug amount discarded/not administered to any patient | 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | SA | Nurse practitioner rendering service in collaboration with a physician | 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 | 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 | LT | Left side (used to identify procedures performed on the left side of the body) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | SL | State supplied vaccine | 93 | Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only 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 away 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 is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. | 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. | 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 | KX | Requirements specified in the medical policy have been met | 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. | CG | Policy criteria applied | CR | Catastrophe/disaster related | CS | Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency | FS | Split (or shared) evaluation and management visit | GE | This service has been performed by a resident without the presence of a teaching physician under the primary care exception | GO | Services delivered under an outpatient occupational therapy plan of care | GT | Via interactive audio and video telecommunication systems | GX | Notice of liability issued, voluntary under payer policy | GZ | Item or service expected to be denied as not reasonable and necessary | K0 | Lower extremity prosthesis functional level 0 - does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility. | KS | Glucose monitor supply for diabetic beneficiary not treated with insulin | 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 | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q5 | Service furnished under a reciprocal billing 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 | 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) | SK | Member of high risk population (use only with codes for immunization) | SQ | Item ordered by home health | X3 | Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 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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| 2020-02-21 | Changed | FDA approval granted on February 21, 2020. |
| 2020-01-01 | Added | Code added. |
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