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 | Vaccines, Toxoids Medicine Services and Procedures |
| 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 | Low |
| Medicare Fee Schedule | View Medicare rates for 90636 |
National average reimbursement for CPT 90636 by major payers:
$123.02
$140.97
$144.41
$141.30
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 90636 | $166.25 | 1447413919 - GHOUSE MOHIUDDIN | 510457240 | IL | Psychiatry Physician (2084P0800X) |
United | 90636 | $141.33 | 1952387318 - MELANY DANEHY | 911780074 | IL | Psychiatry Physician (2084P0800X) |
United | 90636 | $169.96 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 90636 | $151.44 | 1730207820 - KELLI KELLER | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Psychiatry Physician (2084P0800X) |
United | 90636 | $151.13 | 1851464549 - PROGRESSIVE MEDICAL CENTER SC | 363950044 - PROGRESSIVE MEDICAL CENTER, S.C. | IL | Internal Medicine Physician (207R00000X) |
United | 90636 | $168.72 | 1437298361 - ALIYA HAFEEZ | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90636 | $151.44 | 1184658619 - JOHN BECK | 371140016 - CARLE HEALTH CARE INCORPORATED | IL | Psychiatry Physician (2084P0800X) |
United | 90636 | $123.83 | 1033320049 - ANN STECK | 10877201 | OH | Family Medicine Physician (207Q00000X) |
United | 90636 | $166.25 | 1568752665 - ANDREW KNOX | 363907436 - ROCKFORD HEALTH PHYSICIANS | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90636 | $135.63 | 1356352447 - MARLA HARTZEN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90636 | $126.19 | 1609888320 - NANCY SCHELL | 364306053 - PATIENT FIRST INC | IL | Psychiatry Physician (2084P0800X) |
United | 90636 | $168.72 | 1821097924 - AFTAB POSHNI | 363994258 - (IL) HORIZONS BEHAVIORAL HEALTH LLC | IL | Psychiatry Physician (2084P0800X) |
United | 90636 | $247.58 | 1871912683 - LAUREN SCHUMACHER | 943281673 | IL | Psychiatry Physician (2084P0800X) |
United | 90636 | $142.61 | 1881012235 - LAUREN PREST | 910843135 | IL | Psychiatry Physician (2084P0800X) |
United | 90636 | $151.44 | 1386755486 - DOUGLAS NORDLI | 362177139 - UNIVERSITY OF CHICAGO | 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 90636 vs. Other Medicine Services and Procedures Codes
The CPT 90636 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 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-CPT | Low | Hepatitis A Vaccine Solution, A Solution Of Hepatitis A Prepared For A Vaccination. The Vaccine May Be Given In A Series Of Two To Three Shots. |
| 90634-CPT | Low | Hepatitis A Vaccine Solution, A Solution Of Hepatitis A Prepared For A Vaccination. The Vaccine May Be Given In A Series Of Two To Three Shots. |
| 90636-CPT | Low | Hepatitis Ab Vaccine Solution, Combined Hepatitis A And B Vaccine Solution For Adult Injection (Shot). The Vaccine Provides Protection Against Hepatitis A And B Infections. |
| 90647-CPT | Low | Hemophilus Influenza B Vaccine, Hib (Haemophilus Influenza B) Vaccine Solution. Hib Is A Bacteria That Can Cause Serious Infections (Such As Pneumonia Or Meningitis) For Infants And Children. The Vaccine Is Given As A Series Of Three To Four Shots. |
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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