CPT 90678 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 | Vaccines, Toxoids Medicine Services and Procedures |
| Common Place of Service | 11 - Office 60 - Mass Immunization Center |
| Common Modifiers | None PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments JZ - Zero drug amount discarded/not administered to any patient |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 90678 |
National average reimbursement for CPT 90678 by major payers:
$293.88
$330.64
$343.96
$348.35
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 90678 | $398.26 | 1497080584 - ELIZABETH HOMAN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IA | Psychiatry Physician (2084P0800X) |
United | 90678 | $327.75 | 1366883555 - DAVID BANAYAN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | TX | Psychiatry Physician (2084P0800X) |
United | 90678 | $265.50 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 90678 | $354.00 | 1295792265 - MARIE TOBIN | 362177139 - UNIVERSITY OF CHICAGO | IL | Psychiatry Physician (2084P0800X) |
United | 90678 | $295.00 | 1730263617 - MARK ALTER | 910844563 | CA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90678 | $295.00 | 1760412621 - RHONDA LAMPEN | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 90678 | $348.10 | 1700175783 - MY PHON NGUYEN | 363305449 - (IL) MOUNT SINAI COMMUNITY FOUNDATION | IL | Psychiatry Physician (2084P0800X) |
United | 90678 | $295.00 | 1992961643 - CYNTHIA GORDON | 815174138 - (IL) ILLINOIS PROFESSIONALS HEALTH PROGR | IL | Psychiatry Physician (2084P0800X) |
United | 90678 | $345.27 | 1538112859 - FARHA TOKARZ | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90678 | $327.75 | 1033347125 - DAVID HANRAHAN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | CA | Psychiatry Physician (2084P0800X) |
United | 90678 | $327.75 | 1962664789 - JAMIE EVANS | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | NC | Psychiatry Physician (2084P0800X) |
United | 90678 | $326.58 | 1356352447 - MARLA HARTZEN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90678 | $303.85 | 1568752665 - ANDREW KNOX | 391678306 - AURORA MEDICAL GROUP INC | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90678 | $295.00 | 1174859284 - MATTHEW NIEDZWIECKI | 910844563 | CA | Psychiatry Physician (2084P0800X) |
United | 90678 | $324.50 | 1285834440 - LARON PHILLIPS | 842494027 - BRIGHTSIDE MEDICAL | MS | 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 90678 vs. Other Medicine Services and Procedures Codes
The CPT 90678 code is part of the Vaccines, Toxoids services used for Medicine Services and Procedures. 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 90678 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) |
| 90661-CPT | Low | Cciiv3 Vac No Prsv 0 5 Ml Im, Influenza Virus Vaccine Trivalent Cciiv3 Derived From Cell Cultures Subunit Preservative And Antibiotic Free 0 5 Ml Dosage For Intramuscular Use |
| 90677-CPT | Moderate | Pneumonia Vaccine Solution, Solution For The Pneumococcal Vaccine Injection. This Vaccination Is Used To Help Prevent Pneumonia. |
| 90678-CPT | Moderate | Rsv Vaccine Pref Subunit Bivalent For Im Use, Respiratory Syncytial Virus Vaccine Pref Subunit Bivalent 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 90678. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90678 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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