`90695` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 90695

Payer coverage policies that name 90695

90695 appears in 3 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Influenza Vaccines (0035)	covered if criteria are met	Oct 8, 2026	payer document
Aetna	Injectable Medications (0020)	listed, no stance (range 90691-90710)	Mar 5, 2026	payer document
Blue Cross & Blue Shield of Rhode Island	Immunizations Adult and Pediatric MEDICAL COVERAGE POLICY \| 5	covered if criteria are met	Jun 9, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

VT: $0.00 (outpatient_hospital_opps), effective Feb 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.

90695 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 90695

Payer coverage policies that name 90695

Medicaid fee-for-service

`90695` CPT® code: payer coverage and prior authorization