Influenza virus vaccine, split virus, preservative-free, 0.5 mL dosage, for intramuscular use, 3 years of age and older

Q: What is CPT code 90656?

CPT 90656 is the billing code for "Influenza virus vaccine, split virus, preservative-free, 0.5 mL dosage, for intramuscular use, 3 years of age and older". Influenza vaccine, split virus, preservative-free, age 3+

Q: What documentation is required for CPT 90656?

Key documentation requirements for CPT 90656 include: Age documented (3+); Vaccine product documented; Patient response. Missing or incomplete documentation is a leading cause of claim denials for this code.

Q: Can CPT 90656 be billed with other codes?

Bundling considerations for CPT 90656: Vaccine product code. Age 3+ only Use an NCCI bundling checker to verify specific code combinations before billing.

Q: What modifiers are commonly used with CPT 90656?

Common modifiers for CPT 90656 include: 59 (Distinct procedural service). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

Q: What is the time requirement for CPT 90656?

The typical time requirement for CPT 90656 is Vaccine product code. Time-based codes require documentation of the actual time spent providing the service.

Medicine Immunizations 0.00 Total RVUs

Quick Reference

Influenza vaccine, split virus, preservative-free, age 3+

Relative Value Units (RVUs)

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Work RVU

0.00

Physician effort

PE RVU

0.00

Practice expense

MP RVU

0.00

Malpractice

Total RVU

0.00

Combined value

Dollar reimbursement rates vary by locality and payer. RVUs shown for relative comparison only.

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Clinical Information

When to Use

Influenza vaccine, split virus, preservative-free, age 3+

Time Requirement

Vaccine product code

Common Scenarios

Flu vaccine, age 3+

Preservative-free flu vaccine

Split virus flu vaccine

Documentation Requirements

Age documented (3+)
Vaccine product documented
Patient response

Coding Guidelines

Common Modifiers

59 Distinct procedural service

Bundling Rules

Vaccine product code
Age 3+ only
Bill separately from administration

Exclusions

Do not bill if age <3
Do not bill with administration included

Coding Notes

Vaccine product code

Age 3+ only

Related CPT Codes

90471

Immunization administration, first/only vaccine

add-on - use for administration

90654

Influenza vaccine, split virus, preservative-free, age 3+

related - similar vaccine

Clinical scenarios

Flu vaccine, age 3+

When to use:Influenza vaccine, split virus, preservative-free, age 3+

Age documented (3+)
Vaccine product documented
Patient response

Preservative-free flu vaccine

When to use:Influenza vaccine, split virus, preservative-free, age 3+

Age documented (3+)
Vaccine product documented
Patient response

Split virus flu vaccine

When to use:Influenza vaccine, split virus, preservative-free, age 3+

Age documented (3+)
Vaccine product documented
Patient response

Who are you?

Code Details

Code 90656

Category Medicine

Subcategory Immunizations

Total RVUs 0.00

Medicare Pricing

PFS

2025 National Rate

$0.00

Facility

$0.00

Non-Facility

$0.00

RVU Breakdown

Work RVU:0.00PE RVU:0.00MP RVU:0.00Total RVU:0.00CF:$32.3465Global Days:XXX

OPPS Details

Status:LCopayment:$0.00

Dosage: 0.5 ML

Payment Limit: $23.22

ⓘ Physician Fee Schedule: Medicare pays physicians based on Relative Value Units (RVUs) multiplied by a conversion factor.

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Frequently Asked Questions

What is CPT code 90656?

CPT 90656 is the billing code for "Influenza virus vaccine, split virus, preservative-free, 0.5 mL dosage, for intramuscular use, 3 years of age and older". Influenza vaccine, split virus, preservative-free, age 3+

What documentation is required for CPT 90656?

Key documentation requirements for CPT 90656 include: Age documented (3+); Vaccine product documented; Patient response. Missing or incomplete documentation is a leading cause of claim denials for this code.

Can CPT 90656 be billed with other codes?

Bundling considerations for CPT 90656: Vaccine product code. Age 3+ only Use an NCCI bundling checker to verify specific code combinations before billing.

What modifiers are commonly used with CPT 90656?

Common modifiers for CPT 90656 include: 59 (Distinct procedural service). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

What is the time requirement for CPT 90656?

The typical time requirement for CPT 90656 is Vaccine product code. Time-based codes require documentation of the actual time spent providing the service.