CPT 90653 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 | • 60 - Mass Immunization Center • 11 - Office |
| Common Modifiers | • None • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments • GW - Condition not related to the patient's terminal condition |
| Complexity Level | Low |
National average reimbursement for CPT 90653 by major payers:
$79.21
$90.08
$93.01
$94.97
| 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 90653 | ||||||
United | 90653 | $83.48 | 1568752665 - ANDREW KNOX | 362222696 - SWEDISHAMERICAN HOSPITAL | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90653 | $73.36 | 1043522899 - SHARAD KOIRALA | 363305449 - (IL) MOUNT SINAI COMMUNITY FOUNDATION | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90653 | $92.76 | 1245252303 - MARY FAHRMEIER | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | VA | Psychiatry Physician (2084P0800X) |
United | 90653 | $74.69 | 1720087513 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 90653 | $93.51 | 1639673916 - BISHOY GOUBRAN | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 90653 | $93.51 | 1508922964 - COLLEEN BUHRFIEND | 911780160 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90653 | $73.36 | 1275564197 - PAUL BERKOWITZ | 363330928 - (IL) PRESENCE HEALTHCARE SERVICES | IN | Psychiatry Physician (2084P0800X) |
United | 90653 | $94.33 | 1003049966 - GIRISHKUMAR DHORAJIA | 850703768 - (IL) CARLE WEST PHYSICIAN GROUP INC | IL | Psychiatry Physician (2084P0800X) |
United | 90653 | $111.62 | 1033435557 - JESSICA NICHOLSON | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90653 | $92.76 | 1235440058 - CAROLYN DOYLE | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 90653 | $83.48 | 1760412621 - RHONDA LAMPEN | 910844563 | VA | Psychiatry Physician (2084P0800X) |
United | 90653 | $89.73 | 1760461867 - RITA YADAVA | 363878197 - (IL) RITA YADAVA MDSC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90653 | $94.33 | 1790214674 - JENNIFER HARKEY | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 90653 | $106.87 | 1952460933 - LARISSA CHISM BUGGS | 810231784 - BILLINGS CLINIC | IL | Psychiatry Physician (2084P0800X) |
United | 90653 | $98.51 | 1215297221 - STEPHANIE HERNANDEZ | 383989996 | TX | Psychiatry Physician (2084P0800X) |
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 90653 vs. Other Vaccines, Toxoids Codes
The CPT 90653 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 90653 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 |
|---|---|---|
| 90653-CPT | Low | Influenza Vaccine Inactivated (Iiv) Subunit Adjuvanted For Intramuscular Use (Desc Revised 7/1/2015) Second Or Third Opinion Comprehensive Consult (Old Description -Deleted 3/31/2003) |
| 90654-CPT | Low | Influenza Virus Vaccine Trivalent (Iiv3) Split Virus Preservative-Free For Intradermal Use (Desc Revised 01/01/15) |
| 90655-CPT | Low | Influenza Virus Vaccine Trivalent (Iiv3) Split Virus Preservative Free 0.25 Ml Dosage For Intramuscular Use. (Desc Revised 1/1/2017) |
| 90656-CPT | 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 90653. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90653 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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