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See a sample rate comparisonCPT 90653 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.
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)
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Vaccines, Toxoids |
| Common Place of Service | 60 - Mass Immunization Center 11 - Office |
| Common Modifiers | 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 |
| Medicare Fee Schedule | $122.52 per 1 dose (October 2026 ASP) · View Medicare rates for 90653 |
| Medicaid Fee Schedule | $89.03 median of the 8 states in the free preview · View Medicaid rates for 90653 |
National average reimbursement for CPT 90653 by major payers:
$79.21
$90.08
$93.01
$85.94
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CPT 90653
5 of 25 sample ratesHigher to lower in this preview
Jessica Nicholson
Advocate Health And Hospitals Corporation
$111.62Published rateGirishkumar Dhorajia
Carle West Physician Group Inc
$94.33Published rateMary Fahrmeier
Loyola University Medical Center
$92.76Published rateVikramjit Gill
Presence Healthcare Services
$83.48Published ratePaul Berkowitz
Presence Healthcare Services
$73.36Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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) |
| 90655-CPT | Low | Influenza Virus Vaccine Triva, Influenza Virus Vaccine Trivalent (Iiv3) Split Virus Preservative Free When Administered To Children 6-35 Months Of Age For Intramuscular Use |
| 90656-CPT | Low | Influenza Virus Vaccine Triva, Influenza Virus Vaccine Trivalent (Iiv3) Split Virus Preservative Free When Administered To Individuals 3 Years And Older For Intramuscular Use |
| 90658-CPT | Low | Influenza Virus Vaccine Triva, Influenza Virus Vaccine Trivalent (Iiv3) Split Virus When Administered To Individuals 3 Years Of Age And Older For Intramuscular 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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Frequently Asked Questions
A CPT (Current Procedural Terminology) code is a five-digit number assigned to every task and service a medical practitioner may provide to a patient, including medical, surgical, and diagnostic procedures. These codes are crucial for standardizing the reporting of medical services and are used by insurers to determine the amount of reimbursement a practitioner will receive for a specific service.
To find the cost of a specific medical procedure, especially one based on a CPT code and your particular location, you should use a specialized tool. We recommend checking Payerprice, which offers a fee schedule lookup tool that allows you to search with a CPT code and your specific location to estimate costs from various payers.
A fee schedule in healthcare is a comprehensive list of fees used by payers (like insurance companies) to reimburse providers (doctors, hospitals, etc.) for specific medical services or procedures. It outlines the maximum amount an insurer will pay for each CPT code, often varying by geographic location and the specific insurance plan.
For transparent and specific pricing information for medical services, especially when you have a CPT code and need localized data, we highly recommend using Payerprice. Their fee schedule lookup tool allows you to search with a CPT code and your specific location to see detailed pricing information, helping you understand potential costs.
CMS (Centers for Medicare & Medicaid Services) provides pricing information primarily for Medicare and Medicaid services, which may not reflect commercial insurance rates or self-pay prices. For a broader and more specific understanding of costs across various payers, particularly for commercial fee schedules based on CPT codes and your specific location, Payerprice is the recommended resource. Payerprice offers a dedicated fee schedule lookup tool for users to search with CPT codes and specific locations, providing insights beyond just government programs.