CPT 90476 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Vaccines, Toxoids Medicine Services and Procedures |
| Common Place of Service | 11 - Office 50 - Federally Qualified Health Center |
| Common Modifiers | None SL 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 90476 |
National average reimbursement for CPT 90476 by major payers:
$28.93
$40.36
$127.53
$253.13
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 90476 | $40.00 | 1649599168 - RESTORATIVE HEALTH REHABILITATION INC | 272533824 - (FL) RESTORATIVE HEALTH REHABILITATION INC | FL | Home Health Agency (251E00000X) |
United | 90476 | $18.00 | 1225211600 - JOHN MILLICHAP | 731310891 - WARREN CLINIC INC | NC | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90476 | $46.00 | 1275235426 - EMERUS BHS SA THOUSAND OAKS LLC | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 90476 | $55.00 | 1588756076 - ALL WAYS HOMECARE INC | 202696236 | FL | Home Health Agency (251E00000X) |
United | 90476 | $18.00 | 1366428401 - AARON ASKEW | 931261079 - THE ORTHOPEDIC AND NEUROSURGICAL CENTER OF THE CASCADES | OR | Orthopaedic Trauma Physician (207XX0801X) |
United | 90476 | $75.90 | 1881630036 - NOR-LEA HOSPITAL DISTRICT | 850278235 - NOR-LEA HOSPITAL DISTRICT | NM | Critical Access Hospital (282NC0060X) |
United | 90476 | $75.90 | 1841237807 - CHCA MAINLAND, L.P., MAINLAND MEDICAL CENTER | 621801360 | TX | General Acute Care Hospital (282N00000X) |
United | 90476 | $18.00 | 1942682653 - RABIA JAMY | 752654757 - TEXAS NEUROLOGY, P. A. | TX | Neurology Physician (2084N0400X) |
United | 90476 | $46.00 | 1376591941 - HOSPITAL SERVICE DISTRICT 1 OF EAST BATON ROUGE PARISH, LANE REGIONAL MEDICAL CENTER | 726015227 | LA | General Acute Care Hospital (282N00000X) |
United | 90476 | $48.75 | 1063406684 - SAINT JOSEPH'S HOSPITAL, INC. | 580568702 - (GA) SAINT JOSEPHS HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | 90476 | $75.90 | 1881630036 - NOR-LEA HOSPITAL DISTRICT | 850278235 - NOR-LEA HOSPITAL DISTRICT | NM | Critical Access Hospital (282NC0060X) |
United | 90476 | $40.00 | 1588756076 - ALL WAYS HOMECARE INC | 202696236 | FL | Home Health Agency (251E00000X) |
United | 90476 | $60.00 | 1649599168 - RESTORATIVE HEALTH REHABILITATION INC | 272533824 - (FL) RESTORATIVE HEALTH REHABILITATION INC | FL | Home Health Agency (251E00000X) |
United | 90476 | $60.00 | 1588756076 - ALL WAYS HOMECARE INC | 202696236 | FL | Home Health Agency (251E00000X) |
United | 90476 | $18.00 | 1487858072 - GHASSAN ABUSAID | 262400924 | TX | Interventional Cardiology Physician (207RI0011X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 90476 vs. Other Medicine Services and Procedures Codes
The CPT 90476 code is part of the Vaccines, Toxoids services used for Medicine Services and Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 90476 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 90476-CPT | Low | Oral Vaccine For Adenovirus, Vaccine Solution Given By Mouth To Prevent Illnesses Caused By Adenoviruses. Adenoviruses Commonly Cause Lung Illnesses Diarrhea And Eye Infections. |
| 90477-CPT | Low | Oral Vaccine For Adenovirus, Vaccine Solution Given By Mouth To Prevent Illnesses Caused By Adenoviruses. Adenoviruses Commonly Cause Lung Illnesses Diarrhea And Eye Infections. |
| 90581-CPT | Low | Anthrax Vacc For Subcutane Or Intramuscul Use, Anthrax Vaccine For Subcutaneous Or Intramuscular Use |
| 90585-CPT | Low | Bacillus Calmette-Guerin Vacc (Bcg) For Tuberculosis Live, Bacillus Calmette-Guerin Vaccine (Bcg) For Tuberculosis Live For Per |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90476. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90476 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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