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IMPORTANT NOTICE: Updated W-9 for new address 3/1/18 available here.


90687
Quick jump to procedure code: Printer Friendly Version
90690

Procedure Category: Medicine
Procedure Subcategory: Vaccines, Toxoids

90688: IIV4 VACCINE SPLT 0.5 ML IM

CPT® 90688: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use



--

CPT copyright 2017 American Medical Association. All rights reserved.


2018 Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

July 2018 ASP Payment Allowance Limits for Medicare Part B Drugs:
Iiv4 vaccine splt 0.5 ml im, 0.5 ML $ 17.84

2018 OPPS Status Indicator: L

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Percentage
ICD-10 Code
Description
Related DRG(s)
97.5%
Z23
Encounter for immunization
795
951
0.4%
I10
Essential (primary) hypertension
304-305
0.2%
E11.9
Type 2 diabetes mellitus without complications
008
010
637-639
0.2%
Z00.00
Encounter for general adult medical examination without abnormal findings
951
0.1%
J44.9
Chronic obstructive pulmonary disease, unspecified
190-192
0.1%
M54.5
Low back pain
551-552
0.1%
Z28.3
Underimmunization status
951
0.1%
I25.10
Atherosclerotic heart disease of native coronary artery without angina pectoris
302-303
0.1%
E78.5
Hyperlipidemia, unspecified
642
0.0%
E03.9
Hypothyroidism, unspecified
643-645

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

90688 not found in an Local Coverage Determination (LCD) for your contractor. No other coverage policies found in database.

CCI and MUE Edits*         Hide this section.

Multiple Code CCI/MUE Edit Report-New

Column 1 CCI Edits for 90688
Denied Codes (1)
Effective
Modifier
Accepted (2)
36591 DRAW BLOOD OFF VENOUS DEVICE
10/01/2015 No
36592 COLLECT BLOOD FROM PICC
10/01/2015 No
90653 IIV ADJUVANT VACCINE IM
07/01/2013 No
90655 IIV3 VACC NO PRSV 0.25 ML IM
07/01/2013 No
90657 IIV3 VACCINE SPLT 0.25 ML IM
07/01/2013 No
90658 IIV3 VACCINE SPLT 0.5 ML IM
07/01/2013 No
90660 LAIV3 VACCINE INTRANASAL
07/01/2013 No
90661 CCIIV3 VAC NO PRSV 0.5 ML IM
07/01/2013 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
90662 IIV NO PRSV INCREASED AG IM
07/01/2013 No
90664 LAIV VACC PANDEMIC INTRANASL
10/01/2015 Yes
90666 FLU VAC PANDEM PRSRV FREE IM
10/01/2015 Yes
90667 IIV VACC PANDEMIC ADJUVT IM
10/01/2015 Yes
90668 IIV VACCINE PANDEMIC IM
10/01/2015 Yes
90673 RIV3 VACCINE NO PRESERV IM
01/01/2014 No
Q2034 Agriflu vaccine
07/01/2013 No
(1) These codes will be denied when submitted for payment on the same date of service as 90688.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.



Column 2 CCI Edits for 90688

Denied Codes (1)
Effective
Modifier
Accepted (2)
90630 FLU VACC IIV4 NO PRESERV ID
01/01/2015 No
90654 FLU VACC IIV3 NO PRESERV ID
07/01/2013 No
90656 IIV3 VACC NO PRSV 0.5 ML IM
07/01/2013 No
90672 LAIV4 VACCINE INTRANASAL
07/01/2013 No
90674 CCIIV4 VAC NO PRSV 0.5 ML IM
01/01/2017 No
90682 RIV4 VACC RECOMBINANT DNA IM
01/01/2017 No
90685 IIV4 VACC NO PRSV 0.25 ML IM
07/01/2013 No
90686 IIV4 VACC NO PRSV 0.5 ML IM
07/01/2013 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
90687 IIV4 VACCINE SPLT 0.25 ML IM
07/01/2013 No
90756 CCIIV4 VACC ABX FREE IM
01/01/2018 No
Q2035 Afluria vacc, 3 yrs & >, im
07/01/2013 No
Q2036 Flulaval vacc, 3 yrs & >, im
07/01/2013 No
Q2037 Fluvirin vacc, 3 yrs & >, im
07/01/2013 No
Q2038 Fluzone vacc, 3 yrs & >, im
07/01/2013 No
Q2039 Influenza virus vaccine, nos
07/01/2013 No
(1) These codes will be denied when submitted for payment on the same date of service as 90688.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


2018 Medically Unlikely Edits for 90688


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 2 Date of Service Edit: Policy 2 Date of Service Edit: Policy Not Listed
Rationale: Nature of Service/Procedure Nature of Service/Procedure Not Listed

* CCI Source Data: Practitioner P2P Coding Edits. For more information on these edits or to view the Hospital Outpatient Edits, please visit https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html

MUE Source Data: For more information on these edits, please visit href='https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html

The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.



   90688 Top 5 Ordering Providers National* - Extended NPI Market Analysis Search
SIDNEY SUTTON -ELIZABETH CITY,NC 739
M RAHMAN -FALL RIVER,MA 700
ROBERT HILL -KALAMAZOO,MI 654
STANLEY HARVEY -STUART,FL 639
RONALD GOLDFINGER -PITTSFIELD,MA 592

   90688 Top 5 Ordering Organizations National*
SAFEWAY INC-AZ 9,601
ALBERTSONS LLC-ID 4,052
VAXCARE CORPORATION-FL 3,905
AMERICAN DRUG STORES LLC-IL 3,605
FIRST DISTRICT HEALTH UNIT-ND 2,547

*Based on 2016 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 90688*         Hide this section.



Annual Performed / Denied


Total National Services (all modifiers) Submitted 2016: 883,645
Total Services Denied 2016: 38,605 (4.4%)
National Charges Submitted 2016: $ 26,945,373.64
National Charges Allowed 2016: $ 14,987,010.77
National Average (No Modifier) Fee Submitted 2016: $ 30.46
National Average (No Modifier) Fee Allowed 2016: $ 17.73


Top 5 Performing Specialties 2016 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Family practice 318,088 36.0% $ 31.84 14,261 4.5%
Internal medicine 264,705 30.0% $ 35.12 11,015 4.2%
Mass Immunization Roster Biller
(eff. 4/1/03)
99,575 11.3% $ 19.46 5,053 5.1%
Nurse practitioner 43,528 4.9% $ 31.36 2,589 5.9%

Top 5 Places of Service 2016 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 698,941 79.1% $ 33.11 30,169 4.3%
Mass immunizations center (eff. 9/1/97) 159,905 18.1% $ 20.24 5,406 3.4%
State or local public health clinic 11,966 1.4% $ 18.52 928 7.8%
Home 2,644 0.3% $ 29.80 228 8.6%
Urgent Care Facility (eff. 1/1/03) 2,117 0.2% $ 30.40 175 8.3%

Top 5 Modifiers Submitted 2016 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 874,265 98.9% $ 30.46 37,888 4.3%
GA - Advanced Beneficiary Notice (ABN) on File 3,642 0.4% $ 33.75 157 4.3%
59 - Distinct Procedural Service 2,312 0.3% $ 34.40 219 9.5%
GW 1,033 0.1% $ 23.81 69 6.7%
EP 669 0.1% $ 37.33 52 7.8%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

CMS Transmittals Referencing "90688"
Issue DateTransmittalTitle
2017-11-21 R3844CP Replacement of Mammography HCPCS Codes, Waiver of Coinsurance and Deductible for Preventive and Other Services, and Addition of Anesthesia and Prolonged Preventive Services
2017-11-03 R3908CP Influenza Vaccine Payment Allowances - Annual Update for 2017-2018 Season
2017-08-04 R3827CP Quarterly Influenza Virus Vaccine Code Update - January 2018
2017-04-28 R3763CP Payment for Moderate Sedation Services Furnished with Colorectal Cancer Screening Tests
2017-04-21 R3754CP Implementation of New Influenza Virus Vaccine Code
2017-02-03 R3711CP Implementation of New Influenza Virus Vaccine Code


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07/20/2018 07:06:58 54.166.228.35

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