How To Use CPT Code 90694

CPT 90694 describes the administration of a quadrivalent influenza virus vaccine that provides immunity against four strains of the influenza virus. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 90694?

CPT 90694 is used to report the administration of a quadrivalent influenza virus vaccine. This vaccine is designed to protect individuals against four different strains of the influenza virus. It is administered via injection into the patient’s muscle, typically in the deltoid muscle of the upper arm or the anterolateral aspect of the thigh. The vaccine is preservative-free and derived from cell cultures of a killed virus. It also contains an adjuvant, which is a substance that enhances the patient’s immune response to the vaccine.

2. Official Description

The official description of CPT code 90694 is: ‘Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative-free, 0.5 mL dosage, for intramuscular use.’

3. Procedure

1. The healthcare provider presents the options for immunization to the patient, parent, or guardian, explaining the risks, benefits, potential side effects, and providing instructions and precautions.
2. After obtaining informed consent and preparing the patient, the provider administers 0.5 mL of the quadrivalent, adjuvanted, preservative-free influenza vaccine into the patient’s muscle.
3. The injection is typically given in the deltoid muscle of the upper arm or the anterolateral aspect of the thigh.
4. The vaccine is derived from killed virus cultures and is designed to provide immunity against four different strains of the influenza virus.

4. Qualifying circumstances

CPT 90694 is used for patients who require immunization against the influenza virus. It is suitable for individuals who are at risk of contracting the flu or who want to protect themselves from the disease. The vaccine is typically administered to patients of all ages, including children and adults. However, specific age restrictions or recommendations may apply based on the manufacturer’s guidelines and recommendations from public health authorities.

5. When to use CPT code 90694

CPT code 90694 should be used when a healthcare provider administers the quadrivalent influenza virus vaccine to a patient. It is important to ensure that the vaccine administered matches the specific code description, including the adjuvant, preservative-free formulation, and 0.5 mL dosage. If a different formulation or dosage is used, a different CPT code should be reported.

6. Documentation requirements

To support a claim for CPT 90694, the healthcare provider must document the following information:

• Documentation of the patient’s consent for immunization
• Details of the vaccine administered, including the specific brand, formulation, and dosage
• Date of administration
• Route of administration (intramuscular)
• Location of injection (deltoid muscle or anterolateral aspect of the thigh)

7. Billing guidelines

When billing for CPT 90694, ensure that the documentation supports the use of the specific code. The vaccine administered should match the code description, including the adjuvanted, preservative-free formulation and 0.5 mL dosage. It is important to follow the guidelines provided by the payer and any applicable local, state, or federal regulations regarding the administration and billing of influenza vaccines.

8. Historical information

CPT 90694 was added to the Current Procedural Terminology system on January 1, 2020. There have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider administers the quadrivalent influenza virus vaccine to a 65-year-old patient to protect against four different strains of the influenza virus.
2. A nurse administers the quadrivalent influenza virus vaccine to a 4-year-old child to provide immunity against multiple strains of the flu virus.
3. A pharmacist administers the quadrivalent influenza virus vaccine to a pregnant woman to protect her and her unborn child from the flu.
4. A healthcare provider administers the quadrivalent influenza virus vaccine to a group of elderly residents in a nursing home to prevent the spread of the flu within the facility.
5. A pediatrician administers the quadrivalent influenza virus vaccine to a 6-month-old infant to protect against the flu during the upcoming flu season.
6. A healthcare provider administers the quadrivalent influenza virus vaccine to a patient with a compromised immune system to reduce the risk of flu-related complications.
7. A school nurse administers the quadrivalent influenza virus vaccine to a group of students to prevent the spread of the flu within the school community.
8. A healthcare provider administers the quadrivalent influenza virus vaccine to a healthcare worker to protect against the flu and minimize the risk of transmission to patients.
9. A pharmacist administers the quadrivalent influenza virus vaccine to a patient with chronic respiratory conditions to reduce the risk of flu-related exacerbations.
10. A healthcare provider administers the quadrivalent influenza virus vaccine to a patient planning to travel internationally to protect against flu strains prevalent in other countries.