CPT 90611 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 | • 11 - Office • 71 - Public Health Clinic |
| Common Modifiers | • None • 33 - Preventive Services • SL |
| Complexity Level | Moderate |
National average reimbursement for CPT 90611 by major payers:
$256.38
$302.59
$299.37
$312.54
| 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 90611 | ||||||
United | 90611 | $298.91 | 1497080584 - ELIZABETH HOMAN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | MN | Psychiatry Physician (2084P0800X) |
United | 90611 | $298.91 | 1013098631 - PAUL DOBRANSKY | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90611 | $318.60 | 1053570754 - CHRISTOPHER HOLDEN | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 90611 | $302.39 | 1366883555 - DAVID BANAYAN | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 90611 | $318.60 | 1508192048 - DIANA SIECIECHOWICZ | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90611 | $318.60 | 1073697132 - FEDRA NAJJAR | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90611 | $299.97 | 1851376230 - ANITA PAIRITZ | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IN | Psychiatry Physician (2084P0800X) |
United | 90611 | $318.60 | 1508922964 - COLLEEN BUHRFIEND | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90611 | $324.00 | 1639111248 - ROBERT EGEL | 363155454 - (IL) ROBERT T EGEL M D S C | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90611 | $302.39 | 1477181071 - KEVIN VARGHESE | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 90611 | $318.60 | 1659732584 - JOANNA GARCIA PIERCE | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90611 | $310.50 | 1285715847 - SHANNON JENNINGS | 362604009 - (IL) OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER | CO | Psychiatry Physician (2084P0800X) |
United | 90611 | $318.60 | 1578555256 - VIKTORIA ERHARDT | 363317058 - (IL) ACCESS COMMUNITY HEALTH NETWORK | IL | Psychiatry Physician (2084P0800X) |
United | 90611 | $318.60 | 1043606742 - JENIFER LLOYD | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 90611 | $324.00 | 1225211600 - JOHN MILLICHAP | 753186720 | 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 90611 vs. Other Vaccines, Toxoids Codes
The CPT 90611 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 90611 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 |
|---|---|---|
| 90587 | Low | Dengue Vaccine, Quadrivalent, Live, 3 Dose Schedule, For Subcutaneous Use |
| 90611 | Moderate | Smallpox And Monkeypox Vaccine, Attenuated Vaccinia Virus, Live, Non-Replicating, Preservative Free, 0.5 Ml Dosage, Suspension, For Subcutaneous Injection |
| 90611 | Moderate | Smallpox And Monkeypox Vaccine, Attenuated Vaccinia Virus, Live, Non-Replicating, Preservative Free, 0.5 Ml Dosage, Suspension, For Subcutaneous Injection |
| 90620 | Moderate | Meningococcal Recombinant Protein And Outer Membrane Vesicle Vaccine Serogroup B (Menb-4c) 2 Dose Schedule For Intramuscular Use (Desc Revised 7/1/2017) Comprehensive Consultation (Eff. 01011935 - Deleted 03312003) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90611. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90611 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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