90677 CPT® code: payer coverage and prior authorization1 of 1 payer prior-auth lists that name 90677 require prior authorization or set conditions: Rocky Mountain Health Plans.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Rocky Mountain Health Plans | Rocky Mountain Medicare Advantage D-SNP | CO | prior auth required | Feb 1, 2025 | Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025 |
90677 appears in 2 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Pneumococcal Vaccines (0037) | covered if criteria are met | Oct 6, 2026 | payer document |
| Blue Cross & Blue Shield of Rhode Island | Immunizations Adult and Pediatric | covered if criteria are met | Jun 9, 2026 | payer document |
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.