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See a sample rate comparisonCPT 90681 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.
Oral Vaccine For Rotavirus, Rotavirus Vaccine Solution For Oral (By Mouth) Use. The Vaccine Is Given To Prevent Infection With The Rotavirus A Virus Which Causes Severe Diarrhea.
| 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 | View Medicare rates for 90681 |
| Medicaid Fee Schedule | $106.57 median of the 7 states in the free preview · View Medicaid rates for 90681 |
National average reimbursement for CPT 90681 by major payers:
$138.29
$155.01
$159.41
$164.10
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CPT 90681
5 of 25 sample ratesHigher to lower in this preview
Nitin Patel
Southern Illinois Medical Services Nfp
$242.80Published rateJohn Millichap
Pediatric Faculty Foundation In
$163.71Published rateAniruddha Deka
$155.38Published rateLaron Phillips
Brightside Medical
$152.61Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$66.54Published rate
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See a sample payer proposalCPT 90681 vs. Other Vaccines, Toxoids Codes
The CPT 90681 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 90681 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 |
|---|---|---|
| 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 |
| 90673-CPT | Low | Influenza Virus Vaccine Triva, Influenza Virus Vaccine Trivalent (Riv3) Derivedfrom Recombinant Dna (Riv3) Hemagglutinin (Ha) P Rotein Only Preservative And Antibiotic Free Forintramuscular Use |
| 90680-CPT | Low | Oral Vaccine For Rotavirus, Rotavirus Vaccine Solution For Oral (By Mouth) Use. The Vaccine Is Given To Prevent Infection With The Rotavirus A Virus Which Causes Severe Diarrhea. |
| 90681-CPT | Low | Oral Vaccine For Rotavirus, Rotavirus Vaccine Solution For Oral (By Mouth) Use. The Vaccine Is Given To Prevent Infection With The Rotavirus A Virus Which Causes Severe Diarrhea. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90681. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90681 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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