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 | • Medicine Services and Procedures • Vaccines, Toxoids |
| Common Place of Service | • 99 - Other POS • 11 - Office |
| Common Modifiers | • None • 59 - Distinct Procedural Service • SL |
| Complexity Level | Moderate |
National average reimbursement for CPT 90581 by major payers:
$90.73
$110.40
$107.96
$113.11
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 90581 | ||||||
United | 90581 | $99.00 | 1679526784 - ELTON SMITH | 910844563 | PA | Psychiatry Physician (2084P0800X) |
United | 90581 | $116.05 | 1326465436 - MUSADDIQ TARIQ | 510064318 - BAYHEALTH MEDICAL CENTER INC | MS | Psychiatry Physician (2084P0800X) |
United | 90581 | $109.98 | 1114196995 - ANGELA GREEN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | LA | Psychiatry Physician (2084P0800X) |
United | 90581 | $109.58 | 1407807746 - SYED KHAN | 320552496 | IN | Psychiatry Physician (2084P0800X) |
United | 90581 | $55.00 | 1588756076 - ALL WAYS HOMECARE INC | 202696236 | FL | Home Health Agency (251E00000X) |
United | 90581 | $112.50 | 1982268959 - SIDRAH NAJAM | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90581 | $173.25 | 1972543080 - HOSSAM ABDELSALAM | 205521741 - SOUTHERN ILLINOIS MEDICAL SERVICES NFP | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90581 | $118.80 | 1578603593 - ERIN HURST | 362177139 - UNIVERSITY OF CHICAGO | IL | Psychiatry Physician (2084P0800X) |
United | 90581 | $116.05 | 1194049676 - TRACY BINIUS | 410991680 - FAIRVIEW HEALTH SERVICES | IL | Psychiatry Physician (2084P0800X) |
United | 90581 | $98.65 | 1972501252 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 90581 | $99.00 | 1730263617 - MARK ALTER | 910844563 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
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 | $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 | $116.81 | 1851558001 - LUBOV ROMANTSEVA | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
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 Vaccines, Toxoids Codes
The CPT 90581 code is part of the Medicine Services and Procedures services used for Vaccines, Toxoids. 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 | Low | Adenovirus Vaccine Type 4 Live For Oral Use |
| 90477 | Low | Adenovirus Vaccine Type 7 Live For Oral Use |
| 90581 | Low | Vaccine For Anthrax Injection Beneath The Skin Or Into Muscle |
| 90619 | Low | 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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