Prior Auth Required

90656 - no preservative) $25.00 $51.66

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Serviceno preservative) $25.00 $51.66
Procedure / Service Description

Influenza virus vaccine, split virus, preservative free, when Diphtheria, tetanus toxoids, and acellular pertussis vaccine - administered to individuals 3 years and older, for intramuscular and inactivated poliovirus vaccine (DTaP-IPV), when use (Afluria, Fluvarix, Fluvirin, Fluzone influenza virus vaccine, administered to children 4-6 years of age, for IM use 90656 no preservative) $25.00 90696 $51.66 Diphtheria, tetanus toxoids, acellular pertussis vaccine, Influenza virus vaccine, trivalent (IIV3), split virus, 0.25mL haemophilus influenza Type B, and poliovirus vaccine,

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.