CPT 90625 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 • 49 - Independent Clinic • 71 - Public Health Clinic |
| Common Modifiers | • None • GA - Required ABN issued and on file • SL |
| Complexity Level | Moderate |
National average reimbursement for CPT 90625 by major payers:
$269.62
$314.72
$301.59
$318.87
| 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 90625 | ||||||
United | 90625 | $314.69 | 1881918415 - TUSHAR ADVANI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 90625 | $317.23 | 1669598421 - CHANDRIKA SHANKAR | 911780160 | NY | Psychiatry Physician (2084P0800X) |
United | 90625 | $317.23 | 1235766916 - AMIRREZA FALLAHI | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 90625 | $334.23 | 1932355591 - JONATHAN HOWARD | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
United | 90625 | $368.23 | 1164410502 - ALAN FELTHOUS | 430654872 - ST LOUIS UNIVERSITY | IL | Psychiatry Physician (2084P0800X) |
United | 90625 | $419.98 | 1265753867 - ASIFA CHOUDHRY | 850703768 - (IL) CARLE WEST PHYSICIAN GROUP INC | IL | Psychiatry Physician (2084P0800X) |
United | 90625 | $283.25 | 1225211600 - JOHN MILLICHAP | 356005697 | NC | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90625 | $311.57 | 1285834440 - LARON PHILLIPS | 842494027 - BRIGHTSIDE MEDICAL | UT | Psychiatry Physician (2084P0800X) |
United | 90625 | $540.57 | 1760502058 - P. DANIEL LE GRANGE | 943281657 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90625 | $311.57 | 1760412621 - RHONDA LAMPEN | 911352172 - MULTICARE HEALTH SYSTEM | MI | Psychiatry Physician (2084P0800X) |
United | 90625 | $283.25 | 1962664789 - JAMIE EVANS | 910844563 | VA | Psychiatry Physician (2084P0800X) |
United | 90625 | $481.52 | 1740252972 - DAVID HSU | 390817529 - ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90625 | $315.55 | 1205831393 - PRITI SINGH | 461302245 - (IL) ASSOCIATES IN PEDIATRIC NEUROLOGY SC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90625 | $283.25 | 1598375651 - E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC, E AND A HEALTHCARE ON THE GO | 832289173 - (FL) E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC | FL | Home Health Agency (251E00000X) |
United | 90625 | $339.89 | 1164410502 - ALAN FELTHOUS | 430654872 - ST LOUIS UNIVERSITY | 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 90625 vs. Other Vaccines, Toxoids Codes
The CPT 90625 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 90625 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 |
|---|---|---|
| 90477 | Low | Adenovirus Vaccine Type 7 Live For Oral Use |
| 90581 | Low | Vaccine For Anthrax Injection Beneath The Skin Or Into Muscle |
| 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) |
| 90625 | Moderate | Cholera Vaccine , Live, Adult Dosage, 1 Dose Schedule For Oral Use |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90625. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90625 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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