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 | Vaccines, Toxoids Medicine Services and Procedures |
| Common Place of Service | 11 - Office 49 - Independent Clinic |
| Common Modifiers | None SL |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 90626 |
National average reimbursement for CPT 90626 by major payers:
$280.63
$331.43
$320.30
$341.60
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 90626 | $298.10 | 1275564197 - PAUL BERKOWITZ | 363330928 - (IL) PRESENCE HEALTHCARE SERVICES | AZ | Psychiatry Physician (2084P0800X) |
United | 90626 | $351.76 | 1811068554 - JAMES MACKENZIE | 205547757 - (IL) LURIE CHILDRENS MEDICAL GROUP LLC | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90626 | $333.88 | 1356608988 - TRIXIE LIPKE | 391157876 - BEAVER DAM COMMUNITY HOSPITALS INC | IL | Psychiatry Physician (2084P0800X) |
United | 90626 | $351.76 | 1922328426 - MAJED DALLOUL | 364340137 - (IL) SAINT ANTHONY HEALTH AFFILIATES | IL | Psychiatry Physician (2084P0800X) |
United | 90626 | $298.10 | 1962664789 - JAMIE EVANS | 910844563 | NC | Psychiatry Physician (2084P0800X) |
United | 90626 | $357.73 | 1578603593 - ERIN HURST | 362177139 - UNIVERSITY OF CHICAGO | IL | Psychiatry Physician (2084P0800X) |
United | 90626 | $342.82 | 1225211600 - JOHN MILLICHAP | 383852646 - OSF MULTI-SPECIALTY GROUP | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90626 | $298.10 | 1710206545 - NEIL JARIWALA | 910844563 | IN | Psychiatry Physician (2084P0800X) |
United | 90626 | $331.20 | 1942400924 - KATHERINE JOHNSON | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 90626 | $506.79 | 1568752665 - ANDREW KNOX | 390817529 - ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90626 | $336.85 | 1235436288 - AHMAD BASHIR | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 90626 | $298.10 | 1568752665 - ANDREW KNOX | 362222696 - SWEDISHAMERICAN HOSPITAL | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90626 | $361.35 | 1265753867 - ASIFA CHOUDHRY | 850703768 - (IL) CARLE WEST PHYSICIAN GROUP INC | IN | Psychiatry Physician (2084P0800X) |
United | 90626 | $357.73 | 1003166612 - MATTHEW LILLEY | 680637976 - BEND MEMORIAL CLINIC, PC | OR | Orthopaedic Surgery Physician (207X00000X) |
United | 90626 | $298.10 | 1730263617 - MARK ALTER | 910844563 | VA | Child & Adolescent Psychiatry Physician (2084P0804X) |
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 Medicine Services and Procedures Codes
The CPT 90626 code is part of the Vaccines, Toxoids services used for Medicine Services and Procedures. 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-CPT | Low | Dengue Vaccine Quadrivalent Live 3 Dose Schedule For Subcutaneous Use. This Code Is For A Sanofi Pasteur Chimeric Live Attenuated Tetravalent Vaccine That Is Not Yet Fda |
| 90611-CPT | Moderate | Smallpox Monkeypox Vac 0 5ml, Smallpox And Monkeypox Vaccine Attenuated Vaccinia Virus Live Non Replicating Preservative Free 0 5 Ml Dosage Suspension For Subcutaneous Use |
| 90621-CPT | Low | Meningitis Vaccine Solution, Meningococcal Vaccine Solution. The Vaccine Is Given To Prevent Infection With The Meningococcus Bacteria Which Can Cause Meningitis (Infection In The Tissue Surrounding The Brain) And Other Serious Infections. |
| 90626-CPT | Moderate | Tick-Borne Enceph Vacc Inactivated 0.25ml Im Use, 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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