Payer policies › CPT 9068490684 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 90684 Payer coverage policies that name 90684 90684 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
Medicaid fee-for-service AZ: $344.25 (outpatient_hospital), effective Jan 1, 2026 CO: $302.10 (chp_plus_immunizations), effective Jul 1, 2026 FL: $302.10 (immunization), effective Jul 1, 2026 IL: $344.25 (practitioner), effective Apr 1, 2026 IN: $268.96 (professional, Advanced Practice Nurse (85%), non-facility), effective Oct 1, 2025 KS: $344.25 (default), effective Jan 1, 2026 KY: $0.00 (asc), effective Jan 1, 2026 MS: $344.25 (comprehensive), effective Jul 1, 2026 ND: $344.25 (physician), effective Aug 1, 2026 OH: $344.25 (provider_administered_drugs), effective Jan 1, 2026 OK: $322.32 (physician, non-facility), effective Jul 1, 2026 TX: $324.32 (certified_nurse_midwife_cnm, Certified Nurse Midwife (Cnm), non-facility), effective Sep 1, 2026 VA: $344.25 (medical), effective Jan 1, 2026 VT: $311.50 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $344.25 (professional_administered_drugs), effective Jul 1, 2026 WY: $327.89 (professional), effective Oct 1, 2024 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.