90686 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 90686

Payer coverage policies that name 90686

90686 appears in 4 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, BlueCross BlueShield of South Carolina, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaInfluenza Vaccines (0035)covered if criteria are metOct 8, 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
UnitedHealthcarePreventive Care Services (MP.016.59)
VACCINES | Preventive Care Services: Vaccine Codes
listed, no stanceJul 1, 2026payer document

Medicaid fee-for-service

  • AZ: $19.73 (outpatient_hospital), effective Jan 1, 2025
  • CO: $21.90 (chp_plus_immunizations), effective Jul 1, 2026
  • IN: $0.00 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2020
  • KS: $22.35 (default), effective Apr 1, 2024
  • KY: $0.00 (asc), effective Jan 1, 2026
  • LA: $20.04 (immunization_19_20), effective Jan 1, 2025
  • MS: $21.52 (comprehensive), effective Jul 1, 2023
  • ND: $0.00 (physician), effective Aug 1, 2026
  • OH: $21.52 (provider_administered_drugs), effective Oct 1, 2023
  • TX: $22.20 (certified_nurse_midwife_cnm, Certified Nurse Midwife (Cnm), non-facility), effective Mar 1, 2026
  • VA: $22.35 (medical), effective Aug 1, 2023
  • VT: $21.23 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $2.67 (enhanced_pediatric, facility), effective Jul 1, 2026
  • WY: $22.35 (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.