CPT 90658 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 • 50 - Federally Qualified Health Center |
| Common Modifiers | • None • SL • EP - Residential facility to Physician's office |
| Complexity Level | Moderate |
National average reimbursement for CPT 90658 by major payers:
$21.05
$21.80
$24.10
$22.33
| 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 90658 | ||||||
United | 90658 | $19.62 | 1609823194 - SACRED HEART HEALTH SYSTEM INC, SACRED HEART HOME CARE | 590634434 - SACRED HEART HEALTH SYSTEM INC | FL | Home Health Agency (251E00000X) |
United | 90658 | $19.55 | 1013915149 - BAYCARE HOME CARE, INC., DBA SARASOTA MEMORIAL HOME CARE | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 90658 | $19.62 | 1083815435 - HUGO SOLARI | 320115907 - (IL) ESPERANZA HEALTH CENTERS | IL | Psychiatry Physician (2084P0800X) |
United | 90658 | $28.28 | 1720087513 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 90658 | $19.62 | 1750426656 - ANN SARPY | 874515023 - (IL) THRESHOLDS HEALTH NFP | IL | Psychiatry Physician (2084P0800X) |
United | 90658 | $23.55 | 1942330576 - NASIR SYED | 364132865 - (IL) PRIMARY HEALTHCARE ASSOCIATES SC | IL | Psychiatry Physician (2084P0800X) |
United | 90658 | $40.00 | 1801164967 - DA PEDIATRIC REHABILITATION | 270939565 - (FL) DA PEDIATRIC REHABILITATION | FL | Home Health Agency (251E00000X) |
United | 90658 | $35.00 | 1801164967 - DA PEDIATRIC REHABILITATION | 270939565 - (FL) DA PEDIATRIC REHABILITATION | FL | Home Health Agency (251E00000X) |
United | 90658 | $28.28 | 1821081720 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 90658 | $23.55 | 1013279330 - SHO YANO | 362177139 - UNIVERSITY OF CHICAGO | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90658 | $21.80 | 1033347125 - DAVID HANRAHAN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | VA | Psychiatry Physician (2084P0800X) |
United | 90658 | $19.62 | 1366890857 - STEVEN SHARP | 910844563 | OK | Psychiatry Physician (2084P0800X) |
United | 90658 | $21.98 | 1306259817 - KHALID ARSHAD | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90658 | $21.98 | 1477670461 - LOUIS KRAUS | 911780160 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90658 | $20.61 | 1295991701 - TRILOK SHAH | 391127163 - ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN INC | WI | 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 90658 vs. Other Vaccines, Toxoids Codes
The CPT 90658 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 90658 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 | 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 | Low | Influenza Virus Vaccine Trivalent (Iiv3) Split Virus Preservative-Free For Intradermal Use (Desc Revised 01/01/15) |
| 90655 | Low | Influenza Virus Vaccine Trivalent (Iiv3) Split Virus Preservative Free 0.25 Ml Dosage For Intramuscular Use. (Desc Revised 1/1/2017) |
| 90658 | Low | Influenza Virus Vaccine Trivalent (Iiv3) Split Virus 0.5 Ml Dosage For Intramuscular Use. (Desc Revised 1/1/2017) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90658. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90658 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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