CPT 90649 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 • 50 - Federally Qualified Health Center • 99 - Other POS |
| Common Modifiers | • None • SL • EP - Residential facility to Physician's office |
| Complexity Level | Moderate |
National average reimbursement for CPT 90649 by major payers:
$148.62
$183.19
$178.78
$189.46
| 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 90649 | ||||||
United | 90649 | $197.97 | 1326306937 - ANU MATHUR | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Psychiatry Physician (2084P0800X) |
United | 90649 | $164.97 | 1598375651 - E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC, E AND A HEALTHCARE ON THE GO | 832289173 - (FL) E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC | FL | Home Health Agency (251E00000X) |
United | 90649 | $220.57 | 1831432343 - JOHN MCMILLIN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90649 | $164.97 | 1174859284 - MATTHEW NIEDZWIECKI | 910844563 | RI | Psychiatry Physician (2084P0800X) |
United | 90649 | $164.97 | 1679526784 - ELTON SMITH | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 90649 | $184.77 | 1811298987 - ROSARIO COSME CRUZ | 911780160 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90649 | $186.42 | 1427259670 - NADEEM HUSSAIN | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 90649 | $197.97 | 1023112745 - NELDA AKINBILE | 860285857 - EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER INC | IL | Psychiatry Physician (2084P0800X) |
United | 90649 | $194.67 | 1225211600 - JOHN MILLICHAP | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90649 | $197.97 | 1679526784 - ELTON SMITH | 911031583 | IL | Psychiatry Physician (2084P0800X) |
United | 90649 | $216.24 | 1871592881 - CHANDRAGUPTA VEDAK | 363994258 - (IL) HORIZONS BEHAVIORAL HEALTH LLC | IL | Psychiatry Physician (2084P0800X) |
United | 90649 | $194.67 | 1063471159 - MARK WAINWRIGHT | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90649 | $186.42 | 1700278546 - VERONIKA HANKO | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 90649 | $186.42 | 1194049676 - TRACY BINIUS | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 90649 | $236.03 | 1013915149 - BAYCARE HOME CARE, INC., DBA SARASOTA MEMORIAL HOME CARE | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
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 90649 vs. Other Vaccines, Toxoids Codes
The CPT 90649 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 90649 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 |
|---|---|---|
| 90649 | Low | Human Papilloma Virus Vaccine Types 6 11 16 18 Quadrivalent (Hpv4) 3 Dose Schedule For Intramuscular Use (Desc Revised 7/1/2015) |
| 90650 | Low | Human Papilloma Virus Vaccine Types 16 18 Bivalent (Hpv2) 3 Dose Schedule For Intramuscular Use (Desc Revised 7/1/2015) |
| 90651 | Moderate | Human Papillomavirus Vaccine Types 6 11 16 18 31 33 45 52 58 Nonavalent (9vhpv) 2 Or 3 Dose Schedule For Intramuscular Use (Desc Revised 7/1/2017) Second Or Third Opinion Intermediate Consult (Eff. 01011935 - Deleted 03312003) |
| 90656 | Low | Influenza Virus Vaccine, Trivalent, Split Virus Preservative Free, When Administered To Individual 3 Years Or Older, For Intra Muscular Use |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90649. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90649 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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