90644 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 90644

Payer coverage policies that name 90644

90644 appears in 5 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, BlueCross BlueShield of South Carolina.

PayerPolicyRole in policyReviewedDocument
AetnaInjectable Medications (0020)listed, no stance (range 90581-90658)Mar 5, 2026payer document
AetnaMeningococcal Vaccines (0356)covered if criteria are metMay 22, 2026payer document
AetnaVaccines for Travel (0473)listed, no stanceJul 24, 2026payer document
Blue Cross & Blue Shield of Rhode IslandImmunizations Adult and Pediatriccovered if criteria are metJun 9, 2026payer document
BlueCross BlueShield of South CarolinaPreventive Services for Non-Grandfathered (PPACA) Plans: Immunizations (CAM 109)listed, no stanceApr 1, 2026payer document

Medicaid fee-for-service

  • KS: $0.00 (default), effective Jan 1, 2010
  • KY: $115.18 (physician, non-facility), effective Jan 1, 2026
  • MS: $24.70 (comprehensive), effective Jul 1, 2020
  • ND: $0.00 (physician), effective Aug 1, 2026
  • VA: $23.60 (medical), effective Jul 1, 2014
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $23.54 (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.