All PlansCoverageMedium impact
Influenza Vaccines (CPB 0035, reviewed 2026-06-18)
Aetna·Allergy & Immunology, Family Medicine, Internal Medicine +3 more·Medical Policy
Effective date
Jun 18, 2026
We identified it
Aug 16, 2026
Summary
Aetna updated its influenza vaccine policy (CPB 0035) effective June 18, 2026, expanding coverage to include newer mRNA-based influenza vaccines (CPT 90612, 90613, 90616, 90637, 90638, 90639) and quadrivalent formulations, while clarifying that H5N8 bird flu vaccines are not yet recommended for general population coverage. The policy now covers a broader range of FDA-approved influenza vaccines across multiple age groups and delivery methods, including intranasal options for ages 2-49.
Action Required
By June 18, 2026: Billing team must update the billing system to recognize and process the newly expanded mRNA influenza vaccine codes (90612, 90613, 90616, 90637, 90638, 90639) as covered services. Verify that age-based restrictions are correctly configured in the system (e.g., CPT 90638 and 90639 require specific age limits, CPT 90694 restricted to age 65+, FluMist/90672 restricted to ages 2-49). Clinical staff should verify patient age and medical conditions (immunocompromised status, pregnancy, asthma) before administering FluMist per CDC guidelines. Update encounter forms and clinical decision support to reflect that H5N8 bird flu vaccines (CPT 90695) are covered codes but NOT currently recommended by ACIP for general population—flag as non-covered for routine billing unless member is part of a clinical trial or specific government program. Confirm that pandemic formulation codes (90664, 90666, 90667, 90668) are handled separately. Failure to apply correct age restrictions and coverage criteria will result in claim denials or improper reimbursement.