CPT 90636 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 • SK • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Moderate |
National average reimbursement for CPT 90636 by major payers:
$123.02
$140.97
$144.41
$141.55
| 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 90636 | ||||||
United | 90636 | $165.41 | 1629177662 - BARBARA TWARDOWSKI | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90636 | $140.21 | 1376063370 - ABBY FREDRICKSON | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 90636 | $140.21 | 1174859284 - MATTHEW NIEDZWIECKI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | WI | Psychiatry Physician (2084P0800X) |
United | 90636 | $101.75 | 1245466267 - JOSEPH KIPTA | 912151670 - STRAUB CLINIC & HOSPITAL | IL | Psychiatry Physician (2084P0800X) |
United | 90636 | $126.19 | 1962664789 - JAMIE EVANS | 910844563 | NC | Psychiatry Physician (2084P0800X) |
United | 90636 | $151.44 | 1508984907 - DAVID BERRIER | 362177139 - UNIVERSITY OF CHICAGO | IL | Psychiatry Physician (2084P0800X) |
United | 90636 | $148.91 | 1790181402 - SONAM VERMA | 611661781 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90636 | $126.19 | 1629046735 - AQEEL KHAN | 363330928 - (IL) PRESENCE HEALTHCARE SERVICES | CT | Psychiatry Physician (2084P0800X) |
United | 90636 | $151.13 | 1225211600 - JOHN MILLICHAP | 753186720 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90636 | $126.19 | 1225211600 - JOHN MILLICHAP | 454158203 - COMMUNITY CARE NETWORK INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90636 | $151.44 | 1770014920 - JOSEPH PEPITONE | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Psychiatry Physician (2084P0800X) |
United | 90636 | $126.19 | 1174859284 - MATTHEW NIEDZWIECKI | 910844563 | CA | Psychiatry Physician (2084P0800X) |
United | 90636 | $151.44 | 1447549688 - MOHAMMED ALAM | 362177139 - UNIVERSITY OF CHICAGO | IL | Psychiatry Physician (2084P0800X) |
United | 90636 | $140.21 | 1962664789 - JAMIE EVANS | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | WI | Psychiatry Physician (2084P0800X) |
United | 90636 | $126.19 | 1568752665 - ANDREW KNOX | 391678306 - AURORA MEDICAL GROUP INC | WI | 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 90636 vs. Other Vaccines, Toxoids Codes
The CPT 90636 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 90636 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 |
|---|---|---|
| 90633 | Low | Hepatitis A Vaccine Pediatric/Adolescent Dosage-2 Dose Schedule For Intramuscular Use |
| 90634 | Low | Hepatitis A Vaccine Pediatric/Adolescent Dosage-3 Dose Schedule For Intramuscular Use |
| 90636 | Low | Hepatits A And Hepatitis B Vaccine(Hepa-Hepb) Adult Dosage For Intramuscular Use |
| 90647 | Low | Hemophilus Influenza B Vaccine Prp-Omp Conjugate (3 Dose) 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 90636. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90636 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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