CPT 90686: Influenza Vaccine (IIV4, 0.5 mL)
CPT 90686 is the influenza vaccine product code (quadrivalent inactivated, IIV4, preservative-free, 0.5 mL). Vaccine products are not priced on the Medicare Physician Fee Schedule (status X); the product is paid separately. Medicare Part B covers the flu vaccine; commercial plans usually cover it through the pharmacy or preventive benefit.
- Code type
- Vaccine product (influenza IIV4, 0.5 mL)
- PFS status
- X — not priced on the Physician Fee Schedule
- Priced under
- Part B: ~95% of AWP; commercial: pharmacy/preventive benefit
- Admin billed
- Separately (G0008 for Medicare; 90471 commercial)
What is CPT 90686 used for?
CPT 90686 is the influenza vaccine product code — quadrivalent, inactivated (IIV4), preservative-free, 0.5 mL dose for intramuscular use. It identifies the vaccine itself. The administration of the shot is a separate line: 90471 for commercial payers or G0008 for Medicare.
Why is there no fee schedule price for 90686?
Vaccine product codes carry PFS status X — they are not priced on the Physician Fee Schedule at all. Instead the product is paid under a separate methodology:
- Medicare Part B — flu, pneumococcal, and hepatitis B vaccine products are generally paid at about 95% of the average wholesale price (AWP), with CMS publishing the amounts.
- Commercial — paid through the plan's preventive or pharmacy benefit, at plan-specific rates.
So do not look for a physician-fee-schedule dollar amount for 90686; the price comes from the vaccine-pricing files or the commercial contract.
How does Medicare Part B cover the flu vaccine?
Medicare Part B covers the influenza vaccine and its administration with no deductible and no coinsurance for the beneficiary — one of the few first-dollar-covered Part B services. The product is paid at the CMS-published Part B allowance (roughly 95% of AWP), and the administration is paid under G0008.
How do you bill 90686 correctly?
- Bill the product line: 90686 (the vaccine).
- Bill the administration: G0008 for Medicare, or 90471 for commercial payers.
- Add diagnosis Z23 (encounter for immunization).
For the payable services around a vaccine encounter, check locality rates in the Medicare fee calculator, and confirm the vaccine allowed amount from the current CMS vaccine-pricing file rather than assuming a fixed figure. The Tdap product code is 90715.
Frequently asked questions
Vaccine product codes carry PFS status X, meaning they are not priced on the Physician Fee Schedule. The vaccine product is paid separately under a different methodology — for Medicare Part B flu vaccines, generally about 95 percent of the average wholesale price (AWP), updated by CMS.
Yes. Medicare Part B covers the influenza vaccine and its administration with no deductible and no coinsurance for the beneficiary. Bill the product code (90686) plus the Medicare administration code G0008, with diagnosis Z23.
Most commercial plans cover flu vaccination as a preventive service, sometimes through the medical benefit and often through the pharmacy benefit when given at a retail pharmacy. Coverage and payment vary by plan, so verify whether to bill medical or route the patient to pharmacy.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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