90664
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Document vaccine product administered (manufacturer, formulation), lot number, administration date, route (IM vs intranasal), and site (to support vaccine recordkeeping and any adverse event investigation).
- For children requiring 2 doses, document date of first dose and plan/schedule for second dose (second dose 4 weeks after first).
- Document any observed immediate post-vaccination reactions and that routine observation (consider 15 minutes) was conducted to reduce injury risk from syncope.
- If vaccinating persons in isolation/quarantine for COVID-19, document that vaccination would not pose an exposure risk to others in the vaccination setting or that vaccination was deferred until safe.
Key Coverage Criteria
- Vaccination of persons who are pregnant or who might be pregnant during the influenza season.
- Vaccination of children aged 6 months through 8 years who require 2 doses (first dose as soon as possible after vaccine available and second dose 4 weeks later).
- Vaccination should be offered as long as influenza viruses are circulating locally and unexpired vaccine is available; ideally by the end of October but continue thereafter when appropriate.
- Priority vaccination (when supply limited) for: all children aged 6 through 59 months; all persons aged 50 years and older; adults and children with chronic pulmonary (including asthma), cardiovascular (excluding isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus); persons who are immunocompromised; women who are or will be pregnant during the influenza season; children and adolescents (6 months through 18 years) receiving aspirin [...]
- Use of inactivated influenza vaccines (IIV3, IIV4) for persons for whom those products are age- and formulation-appropriate (multiple products described: e.g., Fluarix Quadrivalent, Fluzone Quadrivalent, Flucelvax Quadrivalent).
- Use of high-dose inactivated vaccine (Fluzone High-Dose) and adjuvanted formulations (Fluad/Fluad Quadrivalent) as options for persons aged 65 years and older (CDC/ACIP: any age-appropriate IIV formulation or RIV4 acceptable for 65).
1 Active Policy
AETNA-CPB-0035 — Influenza Vaccine
Related Codes
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