`90587` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 90587

Payer coverage policies that name 90587

90587 appears in 3 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Dengue Vaccine (1010)	covered if criteria are met	Feb 25, 2026	payer document
Aetna	Injectable Medications (0020)	listed, no stance (range 90581-90658)	Mar 5, 2026	payer document
Blue Cross & Blue Shield of Rhode Island	Immunizations Adult and Pediatric	covered if criteria are met	Jun 9, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

AZ: $66.00 (outpatient_hospital), effective Jan 1, 2025
IL: $16.26 (practitioner), effective Apr 1, 2025
ND: $66.00 (physician), effective Aug 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $66.00 (professional_administered_drugs), effective Jul 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

90587 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 90587

Payer coverage policies that name 90587

Medicaid fee-for-service

`90587` CPT® code: payer coverage and prior authorization