Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 90586 Fee Schedule
Last Verified: October 2026
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.
Cancer Treatment With Vaccine, A Solution Of Live Bcg (Tuberculosis) Vaccine Which Is Used As A Treatment For Certain Types Of Bladder Cancer.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Vaccines, Toxoids |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | UD GY - Notice of Liability Not Issued, Not Required Under Payer Policy. |
| Complexity Level | Low |
| Medicare Fee Schedule | $163.97 per 1 dose (January 2026 ASP) · View Medicare rates for 90586 |
| Medicaid Fee Schedule | $161.525 median of the 8 states in the free preview · View Medicaid rates for 90586 |
National average reimbursement for CPT 90586 by major payers:
$163.11
$173.24
$170.54
$182.51
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 90586.
CPT 90586
5 of 25 sample ratesHigher to lower in this preview
Baycare Home Care, Inc.
Baycare Home Care Inc
$240.91Published rateAdventist Health Partners, Inc, Salt Creek Therapy Center
$176.46Published rateRhonda Lampen
Multicare Health System
$165.28Published rateHossam Abdelsalam
$149.53Published rateAll Ways Homecare Inc
$55.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 90586 vs. Other Vaccines, Toxoids Codes
The CPT 90586 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 90586 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. |
| 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 |
| 90586-CPT | Low | Cancer Treatment With Vaccine, A Solution Of Live Bcg (Tuberculosis) Vaccine Which Is Used As A Treatment For Certain Types Of Bladder Cancer. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90586. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90586 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 90586) and we'll show you how you compare in 15 minutes or less.