90672 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 90672

Payer coverage policies that name 90672

90672 appears in 4 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, BlueCross BlueShield of South Carolina.

PayerPolicyRole in policyReviewedDocument
AetnaInfluenza Vaccines (0035)covered if criteria are metOct 8, 2026payer document
AetnaInjectable Medications (0020)listed, no stance (range 90666-90676)Mar 5, 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

  • AZ: $24.50 (outpatient_hospital), effective Jan 1, 2025
  • CO: $27.23 (chp_plus_immunizations), effective Jul 1, 2026
  • IN: $0.00 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2020
  • KS: $27.79 (default), effective Oct 1, 2023
  • KY: $0.00 (asc), effective Jan 1, 2026
  • LA: $23.75 (immunization_19_20), effective Jan 1, 2025
  • MS: $26.88 (comprehensive), effective Jan 1, 2023
  • ND: $0.00 (physician), effective Aug 1, 2026
  • OH: $27.79 (provider_administered_drugs), effective Oct 1, 2023
  • TX: $26.18 (certified_nurse_midwife_cnm, Certified Nurse Midwife (Cnm), non-facility), effective Sep 1, 2024
  • VA: $27.78 (medical), effective Aug 1, 2023
  • VT: $26.40 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $2.67 (enhanced_pediatric, facility), effective Jul 1, 2026
  • WY: $27.79 (professional), effective Oct 1, 2023

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.