Revenue Cycle Insider

Learn what separates vaccines from monoclonal antibodies.

Respiratory diseases are one of the biggest culprits of illnesses, hospitalizations, and deaths in the U.S. each year. Pulmonologists and other providers urge patients to protect themselves against viruses such as influenza, COVID-19, and respiratory syncytial virus (RSV) through immunizations or antibodies.

In July 2025, the Centers for Disease Control and Prevention (CDC) issued the 2025-2026 respiratory vaccine codes for flu, COVID-19, and RSV vaccines and monoclonal antibodies. Revenue Cycle Insider examined the information to ensure your coding knowledge is up to date for the respiratory illness season.

Read on to learn how to report the different vaccines and administrations.

Identify Influenza Vaccine Codes

The vaccines for the 2025-2026 influenza season are trivalent, meaning they are formulated to protect against three different flu viruses. The vaccines help protect against:

• Influenza A (H1N1)
• Influenza A (H3N2)
• Influenza B/Victoria lineage virus

Depending on the dosage, administration method, and patient’s age, you’ll assign one of the following influenza vaccine product CPT^® codes, according to the CDC:

• 90653 (Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use)
• 90656 (Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use)
• 90657 (Influenza virus vaccine, trivalent (IIV3), split virus, 0.25 mL dosage, for intramuscular use)
• 90658 (Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use)
• 90660 (Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use)
• 90661 (Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use)

Administration codes: In addition to reporting the vaccine product CPT^® code, you’re also required to report the administration code. Factors that play into your vaccine administration code selection include administration method, the number of vaccines given at the encounter, and whether the provider performed counseling with the patient. At the same time, the individual payer may only accept certain codes.

Use the following codes when the physician administers the influenza vaccine without counseling:

• 90471 (Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid))
• +90472 (… each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure))
• 90473 (Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid))
• +90474 (… each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure))

However, if the pulmonologist provides immunization counseling, you’ll use the following administration codes:

• 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered)
• +90461 (… each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure))

Finally, report G0008 (Administration of influenza virus vaccine) when the provider administers a flu vaccine to a Medicare patient.

Report COVID-19 Vaccine Codes

On Aug. 27, 2025, the U.S. Food and Drug Administration (FDA) approved new COVID-19 vaccine codes under the biologics license application (BLA) licensure. The FDA also revoked the emergency use authorization (EUA) for the fall 2024 season vaccines in August.

The COVID-19 vaccine product CPT^® codes for 2025-2026 are as follows:

• 91319 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 10 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use)
• 91320 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use)
• 91321 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 25 mcg/0.25 mL dosage, for intramuscular use)
• 91322 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 50 mcg/0.5 mL dosage, for intramuscular use)
• 91323 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 10 mcg/0.2 mL dosage, for intramuscular use)
• 91304 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5 mL dosage, for intramuscular use)

Note: Code 91323 is marked as a new code in the 2026 CPT^® code set because the code was added during the July 2025 code changes, and it will be featured in the CPT^® code book for the first time with the 2026 edition.

Administration codes: The COVID-19 vaccines have their own administration codes, but changes are in store for 2026. If the provider administers a COVID-19 vaccine, you’ll report 90480 (Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, single dose).

However, 90480 will see a descriptor revision starting January 1:

• 2025 descriptor: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, single dose
• 2026 descriptor: Immunization administration by intramuscular injection, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine; first or only component of each vaccine administered

As you can see, the “single dose” in the 2025 descriptor will be replaced by the more detailed explanation underlined in the 2026 descriptor.

The 2026 CPT^® code set also adds +90481 (… each additional component administered (List separately in addition to code for primary procedure)) for COVID-19 vaccine administration.

According to the 2026 CPT^® guidelines, you can report 90480 and +90481 only if the vaccine includes a COVID-19 component. These codes also include administration and counseling of the COVID-19 vaccine.

Protect Patients With RSV Vaccines or Antibodies

RSV is a respiratory virus that causes runny nose, fever, cough, apnea, wheezing, and congestion. Infants and older adults are most likely to experience severe symptoms of the illness.

You’ll use the following CPT^® codes for RSV vaccine products:

• 90678 (Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use)
• 90679 (Respiratory syncytial virus vaccine, preF, recombinant, subunit, adjuvanted, for intramuscular use)
• 90683 (Respiratory syncytial virus vaccine, mRNA lipid nanoparticles, for intramuscular use)

Administration codes: You’ll reach for 90471 or +90472 as appropriate to bill any of the RSV vaccine administrations for adults.

Monoclonal antibodies mimic the antibodies that are produced naturally by the immune system. These differ from vaccines in that monoclonal antibodies offer a type of passive immunity where the antibodies act quickly to fight an infection and help provide long-lasting protection.

The CDC lists the following RSV monoclonal antibody codes when the treatments are used to protect neonates, infants, and children up to 24 months old from RSV during the 2025-2026 season:

• 90380 (Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscular use)
• 90381 (Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramuscular use)
• 90382 (Respiratory syncytial virus, monoclonal antibody, seasonal dose, 0.7 mL, for intramuscular use)

Administration codes: Use administration code 96380 (Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection, with counseling by physician or other qualified health care professional) or 96381 (Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection) to report the RSV monoclonal antibody administration with counseling or without, respectively.

Mike Shaughnessy, BA, CPC, Production Editor, AAPC