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See a sample rate comparisonCPT 90657 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 When Administered To Children 6-35 Months Ofage 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 72 - Rural Health Clinic |
| Common Modifiers | SL EP - Residential facility to Physician's office |
| Complexity Level | Low |
| Medicare Fee Schedule | $11.14 per 1 dose (October 2026 ASP) · View Medicare rates for 90657 |
| Medicaid Fee Schedule | $10.235 median of the 8 states in the free preview · View Medicaid rates for 90657 |
National average reimbursement for CPT 90657 by major payers:
$11.09
$11.29
$12.06
$9.69
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CPT 90657
5 of 25 sample ratesHigher to lower in this preview
Da Pediatric Rehabilitation
$35.00Published rateElizabeth Mirkin
Mount Sinai Community Foundation
$12.06Published rateJonathan Kaplan
$11.44Published rateJohn Millichap
Grady Memorial Hospital Corporation
$10.22Published rateAlabama Heart & Vascular, P. C.
Alabama Heart And Vascular, P.C.
$6.34Published rate
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See a sample payer proposalCPT 90657 vs. Other Vaccines, Toxoids Codes
The CPT 90657 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 90657 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 |
|---|---|---|
| 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 |
| 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 90657. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90657 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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