CPT 2026 · Vaccines/Immunization

CPT 90694

Global XXX

Vacc aiiv4 no prsrv 0.5ml im

Effective 2026-04-01 Conv. factor $33.4009

No national RVU

Payment Methodology

Status Indicator

NCCI Partners

XXX

Global Period

No national RVU

This code does not have a national work RVU on the current Physician Fee Schedule. Pricing may be carrier-determined, non-covered, or tracked via a separate methodology.

CPT 90694 Billing & Documentation Guide

CPT code 90694 (Vacc aiiv4 no prsrv 0.5ml im) is classified under Vaccines/Immunization with a global period indicator of XXX. This code uses the No national RVU payment methodology rather than standard RVU-based Physician Fee Schedule pricing. Refer to the methodology notice above for billing implications.

When billing 90694, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 90694 with related codes; this code has 10 PTP bundling relationships on file (see table below).

Payment Status & Global Period

CMS Status Indicator

Statutory exclusion

Global Period

XXX

No global period (E/M and other non-procedural services)

MUE Limit (Medically Unlikely Edits)

Max units per beneficiary per date of service

Rationale: Code Descriptor / CPT Instruction

Adjudication: Date of Service (Policy)

Source: CMS NCCI MUE Practitioner Services, effective 2026-04-01.

Submitting more than 1 units of 90694 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.

NCCI Bundling Edits, CPT 90694

Procedure-to-procedure (PTP) edits. If you bill any of these codes with 90694 on the same date of service, review the modifier indicator and payer policy before submission.

Partner Code	Relationship	Modifier Allowed	Rationale
36591	Column 1 (primary), can be billed with modifier	No	CPT Manual or CMS manual coding instruction
36592	Column 1 (primary), can be billed with modifier	No	CPT Manual or CMS manual coding instruction
90480	Column 1 (primary), can be billed with modifier	9	CPT Manual or CMS manual coding instruction
90685	Column 1 (primary), can be billed with modifier	No	Mutually exclusive procedures
96523	Column 1 (primary), can be billed with modifier	No	CPT Manual or CMS manual coding instruction
90630	Column 2 (secondary), bundled into primary	No	Mutually exclusive procedures
90653	Column 2 (secondary), bundled into primary	No	Mutually exclusive procedures
90654	Column 2 (secondary), bundled into primary	No	Mutually exclusive procedures
90655	Column 2 (secondary), bundled into primary	No	Mutually exclusive procedures
90656	Column 2 (secondary), bundled into primary	No	Mutually exclusive procedures

Frequently Asked Questions, CPT 90694

What does CPT code 90694 mean? +

CPT code 90694 represents: Vacc aiiv4 no prsrv 0.5ml im. It's in the Vaccines/Immunization category with a global period of XXX.

What is the Medicare reimbursement for CPT 90694? +

This code does not have a national work RVU on the current Physician Fee Schedule. Pricing may be carrier-determined, non-covered, or tracked via a separate methodology.

What modifiers can I use with CPT 90694? +

Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.

What bundling edits apply to CPT 90694? +

This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.