CPT 90626 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 |
| Common Modifiers | • None • SL |
| Complexity Level | Moderate |
National average reimbursement for CPT 90626 by major payers:
$280.63
$331.43
$320.30
$337.64
| 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 90626 | ||||||
United | 90626 | $253.38 | 1225211600 - JOHN MILLICHAP | 262037695 - GRADY MEMORIAL HOSPITAL CORPORATION | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90626 | $298.10 | 1962664789 - JAMIE EVANS | 910844563 | WI | Psychiatry Physician (2084P0800X) |
United | 90626 | $357.73 | 1740252972 - DAVID HSU | 390884478 - BELLIN MEMORIAL HOSPITAL INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90626 | $327.92 | 1003140880 - LESLIE FINKEL | 363738206 - NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90626 | $298.10 | 1376822486 - AMAL ASIRI | 475419443 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90626 | $320.42 | 1194974600 - GAURAV YADAVA | 363878197 - (IL) RITA YADAVA MDSC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90626 | $298.10 | 1962664789 - JAMIE EVANS | 910844563 | CA | Psychiatry Physician (2084P0800X) |
United | 90626 | $320.42 | 1760907133 - ILLINOIS PROFESSIONALS HEALTH PROGRAM, LLC | 815174138 - (IL) ILLINOIS PROFESSIONALS HEALTH PROGR | IL | Psychiatry Physician (2084P0800X) |
United | 90626 | $320.42 | 1215968755 - STACEY OCCOMY | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IN | Psychiatry Physician (2084P0800X) |
United | 90626 | $351.76 | 1871054817 - ERIC ZIMMERMAN | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 90626 | $327.92 | 1285834440 - LARON PHILLIPS | 842494027 - BRIGHTSIDE MEDICAL | KS | Psychiatry Physician (2084P0800X) |
United | 90626 | $320.42 | 1104993161 - BETH LEDVORA | 463010946 - (IL) BETH LEDVORA M.D., S.C. | IL | Psychiatry Physician (2084P0800X) |
United | 90626 | $398.54 | 1871592881 - CHANDRAGUPTA VEDAK | 363994258 - (IL) HORIZONS BEHAVIORAL HEALTH LLC | IL | Psychiatry Physician (2084P0800X) |
United | 90626 | $333.88 | 1851558001 - LUBOV ROMANTSEVA | 911780120 - (IL) RUSH UNIVERSITY MEDICAL CENTER | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90626 | $298.10 | 1568533701 - REGINALD GIVENS | 362222696 - SWEDISHAMERICAN HOSPITAL | 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 90626 vs. Other Vaccines, Toxoids Codes
The CPT 90626 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 90626 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 |
| 90621 | Low | Meningococcal Recombinant Lipoprotein Vaccine Serogroup B (Menb-Fhbp) 2 Or 3 Dose Schedule For Intramuscular Use (Desc Revised 7/1/2017) |
| 90626 | Moderate | Tick-Borne Encephalitis Virus Vaccine, Inactivated; 0.25 Ml Dosage, 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 90626. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90626 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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