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See a sample rate comparisonCPT 90638 Fee Schedule
Last Verified: October 2026
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.
Flu Vaccine Solution, Influenza (Flu Shot) Vaccine Given By Injection Intended To Protect Against Illness Caused By One Or More Flu Viruses (Influenza).
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Vaccines, Toxoids |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 90638 |
| Medicaid Fee Schedule | $78.975 median of the 2 states in the free preview · View Medicaid rates for 90638 |
National average reimbursement for CPT 90638 by major payers:
$38.88
$N/A
$N/A
$99,999.77
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CPT 90638
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See a sample payer proposalCPT 90638 vs. Other Vaccines, Toxoids Codes
The CPT 90638 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 90638 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 |
|---|---|---|
| 90638-CPT | Low | Flu Vaccine Solution, Influenza (Flu Shot) Vaccine Given By Injection Intended To Protect Against Illness Caused By One Or More Flu Viruses (Influenza). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90638. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90638 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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