CPT 90686 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 90686 by major payers:
$24.52
$25.16
$24.51
$32.02
| 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 90686 | ||||||
United | 90686 | $20.00 | 1558349860 - WARREN HARDY | 852793496 - (AL) MOBILE HEART USA LLC | AL | Interventional Cardiology Physician (207RI0011X) |
United | 90686 | $22.35 | 1548224157 - CARDIOLOGY CONSULTANTS PC | 630837257 - (AL) CARDIOLOGY CONSULTANTS, P.C. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 90686 | $22.35 | 1912282948 - IMRAN KHALIL | 61330992 - NORTHEAST MEDICAL GROUP INC | AL | Interventional Cardiology Physician (207RI0011X) |
United | 90686 | $26.59 | 1801897772 - BANKIMCHANDRA PATEL | 631171060 - (AL) NORTH ALABAMA CARDIOLOGY CENTER, P.C. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 90686 | $23.53 | 1952353153 - WILLIAM COX | 631211664 - (AL) HUNTSVILLE CARDIOVASCULAR CLINIC, P.C. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 90686 | $26.59 | 1861446866 - MONICA HUNTER | 631185612 - (AL) SOUTHVIEW MEDICAL GROUP, P.C. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 90686 | $27.77 | 1679507875 - FIRAS AL SOLAIMAN | 352526373 - ACCLAIM PHYSICIAN GROUP INC | AL | Interventional Cardiology Physician (207RI0011X) |
United | 90686 | $27.05 | 1588870224 - STANLEY THORNTON | 630889615 - (AL) CARDIOLOGY ASSOCIATES OF MOBILE, INC. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 90686 | $19.95 | 1295739274 - ALVARO ALDANA | 383976603 | AL | Interventional Cardiology Physician (207RI0011X) |
United | 90686 | $45.25 | 1245587765 - ZAKARIA ALMUWAQQAT | 260593928 | AL | Interventional Cardiology Physician (207RI0011X) |
United | 90686 | $23.95 | 1386085793 - ASHWINI SHARMA | 630691533 - (AL) MONTGOMERY CARDIOVASCULAR ASSOCIATES, P.C. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 90686 | $28.84 | 1720417793 - ZUBAIR KHAN | 272451336 | NV | Interventional Cardiology Physician (207RI0011X) |
United | 90686 | $20.00 | 1982638383 - HENRY FLEMMING | 630691533 - (AL) MONTGOMERY CARDIOVASCULAR ASSOCIATES, P.C. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 90686 | $19.95 | 1588109599 - CITRIN CARDIOLOGY PC | 814661745 - (AL) CITRIN CARDIOLOGY PC | AL | Interventional Cardiology Physician (207RI0011X) |
United | 90686 | $22.35 | 1326077058 - MICHAEL MANSOUR | 631012832 | AL | Interventional Cardiology Physician (207RI0011X) |
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 90686 vs. Other Vaccines, Toxoids Codes
The CPT 90686 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 90686 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 | Low | Influenza Virus Vaccine Trivalent (Iiv3) Split Virus 0.5 Ml Dosage For Intramuscular Use. (Desc Revised 1/1/2017) |
| 90685 | Low | Influenza Virus Vaccine Quadrivalent (Iiv4) Split Virus Preservative Free 0.25 Ml Dosage For Intramuscular Use. (Desc Revised 1/1/2017) |
| 90686 | Low | Influenza Virus Vaccine, Quadrivalent, Split Virus, Preservative Free, When Administered To Individuals 3 Years Of Age And Older, For Intramuscular Use |
| 90687 | Low | Influenza Virus Vaccine Quadrivalent (Iiv4) Split Virus 0.25 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 90686. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90686 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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