CPT 90581 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 | 99 - Other POS 11 - Office |
| Common Modifiers | None 59 - Distinct Procedural Service SL |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 90581 |
National average reimbursement for CPT 90581 by major payers:
$90.73
$110.40
$107.96
$114.91
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 90581 | $116.81 | 1851558001 - LUBOV ROMANTSEVA | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90581 | $118.80 | 1063520781 - ELLIOT GERSHON | 362177139 - UNIVERSITY OF CHICAGO | IL | Psychiatry Physician (2084P0800X) |
United | 90581 | $111.87 | 1891921367 - KAVITA THAKKAR | 363097297 - NORTHWESTERN MEMORIAL HEALTHCARE | PA | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90581 | $118.80 | 1144267865 - NITIN PATEL | 462706345 | MO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90581 | $116.81 | 1578531950 - DAVID RITACCO | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90581 | $109.98 | 1962664789 - JAMIE EVANS | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | MT | Psychiatry Physician (2084P0800X) |
United | 90581 | $112.50 | 1033328869 - LEAH USTAS | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90581 | $99.00 | 1609823194 - SACRED HEART HEALTH SYSTEM INC, SACRED HEART HOME CARE | 590634434 - SACRED HEART HEALTH SYSTEM INC | FL | Home Health Agency (251E00000X) |
United | 90581 | $99.00 | 1972543080 - HOSSAM ABDELSALAM | 363978153 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90581 | $99.00 | 1609823194 - SACRED HEART HEALTH SYSTEM INC, SACRED HEART HOME CARE | 590634434 - SACRED HEART HEALTH SYSTEM INC | FL | Home Health Agency (251E00000X) |
United | 90581 | $106.41 | 1255892808 - ASHLEY SHI | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90581 | $106.41 | 1497080584 - ELIZABETH HOMAN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | MN | Psychiatry Physician (2084P0800X) |
United | 90581 | $112.50 | 1952795254 - MALCOLM VANDREVALA | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90581 | $132.36 | 1205831393 - PRITI SINGH | 461302245 - (IL) ASSOCIATES IN PEDIATRIC NEUROLOGY SC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90581 | $77.62 | 1114472867 - MARCUS BYRD | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
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 90581 vs. Other Medicine Services and Procedures Codes
The CPT 90581 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 90581 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 |
| 90619-CPT | Low | Meningococcal Conjugate Vaccin, Meningococcal Conjugate Vaccine Serogroups A C W Y Quadrivalent Tetanus Toxoid Carrier (Menacwy-Tt) For Intramuscular Use |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90581. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90581 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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