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See a sample rate comparisonCPT 90656 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 Virus Vaccine Triva, Influenza Virus Vaccine Trivalent (Iiv3) Split Virus Preservative Free When Administered To Individuals 3 Years And Older For Intramuscular Use
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Vaccines, Toxoids |
| Common Place of Service | 11 - Office 50 - Federally Qualified Health Center |
| Common Modifiers | SL EP - Residential facility to Physician's office |
| Complexity Level | Low |
| Medicare Fee Schedule | $23.89 per 1 dose (October 2026 ASP) · View Medicare rates for 90656 |
| Medicaid Fee Schedule | $21.87 median of the 8 states in the free preview · View Medicaid rates for 90656 |
National average reimbursement for CPT 90656 by major payers:
$23.32
$22.89
$25.62
$22.47
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CPT 90656
5 of 25 sample ratesHigher to lower in this preview
Kimberly Rodda
$30.00Published rateMegan Barton
$24.53Published rateChristie Rivelli
$24.53Published rateMary Garwood
$23.10Published rateDaniel Salter
$20.44Published rate
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See a sample payer proposalCPT 90656 vs. Other Vaccines, Toxoids Codes
The CPT 90656 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 90656 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 |
| 90657-CPT | Low | Influenza Virus Vaccine Triva, Influenza Virus Vaccine Trivalent (Iiv3) Split Virus When Administered To Children 6-35 Months Ofage 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 90656. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90656 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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