Reimbursement information
CPT code for CAPVAXIVE1: 90684
The information provided here is compiled from sources believed to be accurate, but Merck makes no representation that it is accurate. Consult the relevant manual and/or other guidelines for a description of each code to determine the appropriateness of a particular code and for information on additional codes. This information is subject to change. Merck cautions that payer coding requirements vary and can frequently change, so it’s important to regularly check with each payer as to payer-specific requirements.
You are solely responsible for determining the appropriate codes and for any action you take in billing. The information provided here is not intended to be definitive or exhaustive, and is not intended to replace the guidance of a qualified professional advisor. Merck makes no warranties or guarantees, expressed or implied, concerning the accuracy or appropriateness of this information for your particular use given the frequent changes in public and private payer billing. The use of this information does not guarantee payment or that any payment received will cover your costs. Diagnosis codes should be selected only by a health care professional.
Commercial insurance may provide coverage for employed adult patients aged 19 to 64 years
Some vaccinating pharmacies may be able to adjudicate commercial medical claims for vaccinations.
- When the pharmacy is signed up with the relevant medical insurer to process medical claims or when the claim can be processed through a pharmacy benefit manager (PBM)
- Vaccines reimbursed under a medical benefit are usually provided at an in-network physician’s office
Consult private insurer or public program for reimbursement details.
Remember: The reimbursement-related information in this resource is general in nature. This information is subject to change. It is not intended to be exhaustive, nor to replace the guidance of a qualified reimbursement advisor, and does not constitute legal or reimbursement advice. The use of the information presented here is not a guarantee of coverage or payment. As a provider, you are solely responsible for billing payers correctly and for determining whether any payer-specific guidelines apply. Merck does not guarantee or ensure the timeliness or appropriateness of this information for your particular use given the frequent changes in public and private payer billing.
Share with health care professionals
CPT, Current Procedural Terminology. CPT is a registered trademark of the American Medical Association.
Reference:
- CPT® category I new immunization vaccine codes (including incorporation of ACIP abbreviations listing) long descriptors. American Medical Association. Updated October 18, 2024. Accessed November 5, 2024. https://www.ama-assn.org/system/files/vaccine-long-descriptors.pdf