CPT 90655 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 • 71 - Public Health Clinic • 50 - Federally Qualified Health Center |
| Common Modifiers | • None • SL • EP - Residential facility to Physician's office |
| Complexity Level | Low |
National average reimbursement for CPT 90655 by major payers:
$17.04
$14.00
$18.33
$14.37
| 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 90655 | ||||||
United | 90655 | $16.62 | 1356723811 - VICTOR PATRON ROMERO | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 90655 | $14.84 | 1366540072 - DHRUV PATEDER | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Orthopaedic Surgery of the Spine Physician (207XS0117X) |
United | 90655 | $17.90 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 90655 | $19.89 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 90655 | $14.84 | 1275564197 - PAUL BERKOWITZ | 363330928 - (IL) PRESENCE HEALTHCARE SERVICES | FL | Psychiatry Physician (2084P0800X) |
United | 90655 | $14.84 | 1730263617 - MARK ALTER | 910844563 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90655 | $14.84 | 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 | 90655 | $35.00 | 1649599168 - RESTORATIVE HEALTH REHABILITATION INC | 272533824 - (FL) RESTORATIVE HEALTH REHABILITATION INC | FL | Home Health Agency (251E00000X) |
United | 90655 | $17.80 | 1699752204 - CATHERINE CAMILLERI | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Psychiatry Physician (2084P0800X) |
United | 90655 | $14.84 | 1871907774 - ODAY ALSARRAF | 362222696 - SWEDISHAMERICAN HOSPITAL | SC | Psychiatry Physician (2084P0800X) |
United | 90655 | $15.94 | 1104993161 - BETH LEDVORA | 463010946 - (IL) BETH LEDVORA M.D., S.C. | IL | Psychiatry Physician (2084P0800X) |
United | 90655 | $17.80 | 1679739395 - BETSY OSTRANDER | 810232122 - BENEFIS HOSPITALS INC | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90655 | $15.82 | 1295728186 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 90655 | $5.94 | 1366400376 - SUNRISE HOME HEALTH CARE INC. | 650307774 - (FL) SUNRISE HOME HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 90655 | $15.94 | 1992961643 - CYNTHIA GORDON | 815174138 - (IL) ILLINOIS PROFESSIONALS HEALTH PROGR | IL | 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 90655 vs. Other Vaccines, Toxoids Codes
The CPT 90655 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 90655 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 90655. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90655 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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