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See a sample rate comparisonHealthcare 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 71 - Public Health Clinic |
| Common Modifiers | SL GA - Required ABN issued and on file |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 90691 |
| Medicaid Fee Schedule | $120.27 median of the 8 states in the free preview · View Medicaid rates for 90691 |
National average reimbursement for CPT 90691 by major payers:

$122.62

$155.15

$153.76

$142.63
Choose a payer to see a sample of rates for CPT 90691.
Serena Wong
Westchester Medical Center Advanced Physician Services PC
Andras Peter
Sukhwinder Hundle
Carmen Garmendia
Senior Healthcare Outreach Program
Joseph Luayon
Prime Health Group LLC
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Rate Benchmarking
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See a sample rate comparisonPayer Contract Negotiation
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See a sample payer proposalCPT 90691 vs. Other Vaccines, Toxoids Codes
The CPT 90691 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 90691 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 |
|---|---|---|
| 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 |
| 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. |
| 90690-CPT | Low | Typhoid Vaccine For Oral Use, Typhoid Vaccine Solution Given By Mouth (Oral). Typhoid Is A Bacteria That Can Cause Serious Infection. It Is Spread By Contaminated Food And Water. |
| 90691-CPT | Low | Typhoid Vaccine Solution, Typhoid Vaccine Solution. Typhoid Is A Bacteria That Can Cause Serious Infection. It Is Spread By Contaminated Food And Water. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90691. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90691 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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