CPT 90695 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 | |
| Common Modifiers | |
| Complexity Level | Moderate |
National average reimbursement for CPT 90695 by major payers:
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| 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 90695 | ||||||
United | 90695 | $0.01 | 1740252972 - DAVID HSU | 390817529 - ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90695 | $0.01 | 1932272952 - MOHAMMED HOMSI | 364143823 - SIU PHYSICIANS & SURGEONS INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90695 | $0.01 | 1225211600 - JOHN MILLICHAP | 800863895 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90695 | $0.01 | 1326177809 - LAURA SHEA | 364143823 - SIU PHYSICIANS & SURGEONS INC | IL | Psychiatry Physician (2084P0800X) |
United | 90695 | $0.01 | 1760502058 - P. DANIEL LE GRANGE | 943281657 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90695 | $0.01 | 1740252972 - DAVID HSU | 390817529 - ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90695 | $0.01 | 1225211600 - JOHN MILLICHAP | 800863895 | NC | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90695 | $0.01 | 1871912683 - LAUREN SCHUMACHER | 943281660 | CA | Psychiatry Physician (2084P0800X) |
United | 90695 | $0.01 | 1760502058 - P. DANIEL LE GRANGE | 943281660 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90695 | $0.01 | 1790936540 - SRISHTI NANGIA | 131623978 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90695 | $0.01 | 1649574336 - BLESSING HOSPITAL, BLESSING BEHAVIORAL CENTER | 370661183 - BLESSING HOSPITAL | IL | Psychiatry Physician (2084P0800X) |
United | 90695 | $0.01 | 1760502058 - P. DANIEL LE GRANGE | 943281673 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90695 | $0.01 | 1164410502 - ALAN FELTHOUS | 201957741 | IL | Psychiatry Physician (2084P0800X) |
United | 90695 | $0.01 | 1568752665 - ANDREW KNOX | 390817529 - ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90695 | $0.01 | 1871912683 - LAUREN SCHUMACHER | 943281660 | IL | 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 90695 vs. Other Vaccines, Toxoids Codes
The CPT 90695 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 90695 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 |
|---|---|---|
| 90695 | Moderate | Influenza Virus Vaccine, H5n8, Derived From Cell Cultures, Adjuvanted, 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 90695. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90695 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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