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See a sample rate comparisonCPT 90685 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 (Cciiv3) Derived From Cell Cultures Subunit Preservative And Antibiotic Free 0.5 Ml Dosage 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 | View Medicare rates for 90685 |
| Medicaid Fee Schedule | $19.27 median of the 7 states in the free preview · View Medicaid rates for 90685 |
National average reimbursement for CPT 90685 by major payers:
$23.20
$24.42
$22.81
$32.44
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CPT 90685
5 of 25 sample ratesHigher to lower in this preview
Matthew Lilley
Bend Memorial Clinic, PC
$27.34Published rateEric Zimmerman
The Board Of Trustees Of The University Of Illinois
$26.87Published rateAndrew Knox
Rockford Health Physicians
$25.05Published rateGregg Bean
South Texas Radiology Group, P.A.
$22.78Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$19.36Published rate
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See a sample payer proposalCPT 90685 vs. Other Vaccines, Toxoids Codes
The CPT 90685 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 90685 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 |
|---|---|---|
| 90685-CPT | Low | Influenza Virus Vaccine Triva, Influenza Virus Vaccine Trivalent (Cciiv3) Derived From Cell Cultures Subunit Preservative And Antibiotic Free 0.5 Ml Dosage For Intramuscular Use |
| 90686-CPT | Low | Influenza Virus Vaccine Quadr, Influenza Virus Vaccine Quadrivalent (Iiv4) Split Virus Preservative Free When Administered To Individuals 3 Years Of Age And Older For Intramuscular Use |
| 90687-CPT | Low | Influenza Virus Vaccine Triva, Influenza Virus Vaccine Trivalent (Cciiv3) Derived From Cell Cultures Subunit Preservative And Antibiotic Free 0.5 Ml Dosage For Intramuscular Use |
| 90688-CPT | Low | Influenza Virus Vaccine Quadr, Influenza Virus Vaccine Quadrivalent (Iiv4) 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 90685. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90685 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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