CPT 90651 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 |
| Common Modifiers | • None • SL • EP - Residential facility to Physician's office |
| Complexity Level | Moderate |
National average reimbursement for CPT 90651 by major payers:
$291.31
$343.32
$361.58
$348.50
| 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 90651 | ||||||
United | 90651 | $472.41 | 1396790390 - LEAH BECICKA | 382908586 - ASPIRUS IRONWOOD HOSPITAL & CLINICS INC | MN | Obstetrics & Gynecology Physician (207V00000X) |
United | 90651 | $344.89 | 1659489474 - JANICE GIBSON-NEALE | 203639329 | VA | Obstetrics & Gynecology Physician (207V00000X) |
United | 90651 | $268.76 | 1134197361 - RANDY YARBROUGH | 631058174 - CULLMAN REGIONAL MEDICAL CENTER INC | AL | Obstetrics & Gynecology Physician (207V00000X) |
United | 90651 | $362.98 | 1992122410 - DIVAKAR MITHAL | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90651 | $339.29 | 1801813266 - GREGG BEAN | 741586031 | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 90651 | $322.51 | 1952465908 - CRISTAL LYNCH | 330593837 | CA | Obstetrics & Gynecology Physician (207V00000X) |
United | 90651 | $698.00 | 1467748855 - KRISTIN TAYLOR | 951644600 - CEDARS-SINAI MEDICAL CENTER | CA | Obstetrics & Gynecology Physician (207V00000X) |
United | 90651 | $287.52 | 1457774861 - CORRINE MAUND | 362222696 - SWEDISHAMERICAN HOSPITAL | IL | Obstetrics & Gynecology Physician (207V00000X) |
United | 90651 | $362.98 | 1184661407 - MICHAEL BEDNARZ | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
United | 90651 | $409.36 | 1376931113 - RUTH FARRELL | 264045534 - TANNER MEDICAL CENTER | GA | Obstetrics & Gynecology Physician (207V00000X) |
United | 90651 | $586.98 | 1194847871 - ROMEO AMBROSIO | 611276316 - COMMUNITY MEDICAL ASSOCIATES INC | KY | Obstetrics & Gynecology Physician (207V00000X) |
United | 90651 | $341.75 | 1962664789 - JAMIE EVANS | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | WI | Psychiatry Physician (2084P0800X) |
United | 90651 | $282.20 | 1942628672 - CLAIRE FAGGONS | 831002191 - TEMPLE FACULTY PRACTICE PLAN INC | PA | Obstetrics & Gynecology Physician (207V00000X) |
United | 90651 | $307.67 | 1962664789 - JAMIE EVANS | 910844563 | VA | Psychiatry Physician (2084P0800X) |
United | 90651 | $307.60 | 1235636648 - KATHERINE ROBERTS | 753186720 | WA | Obstetrics & Gynecology Physician (207V00000X) |
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 90651 vs. Other Vaccines, Toxoids Codes
The CPT 90651 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 90651 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 90651. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90651 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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