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See a sample rate comparisonCPT 90696 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.
Diphtheria Tetanus Toxoids A, Diphtheria Tetanus Toxoids Acellular Pertussis Vaccine And Poliovirus Vaccine Inactivated (Dtap-Ipv) When Administered To Children 4 Years Through6 Years Of Age 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 90696 |
| Medicaid Fee Schedule | $48.00 median of the 7 states in the free preview · View Medicaid rates for 90696 |
National average reimbursement for CPT 90696 by major payers:
$69.49
$68.81
$74.24
$78.83
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CPT 90696
5 of 25 sample ratesHigher to lower in this preview
Hossam Abdelsalam
Siu Physicians & Surgeons Inc
$145.39Published rateLauren Prest
$72.69Published rateKaren Severson
Loyola University Medical Center
$68.69Published rateMark Alter
$61.83Published rateCamilla Grant
Town Center Orthopaedic Associates, P.C.
$57.22Published rate
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See a sample payer proposalCPT 90696 vs. Other Vaccines, Toxoids Codes
The CPT 90696 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 90696 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 |
|---|---|---|
| 90644-CPT | Low | Meningococcal Conjugate Vaccine Serogroups C & Y And Haemophilus Influenzae B Vaccine (Hib-Mency) 4 Dose Schedule When Administered To Children 6 Weeks-18 Months Of Age For Intramuscular Use (Description Revised 1/1/2016) |
| 90696-CPT | Low | Diphtheria Tetanus Toxoids A, Diphtheria Tetanus Toxoids Acellular Pertussis Vaccine And Poliovirus Vaccine Inactivated (Dtap-Ipv) When Administered To Children 4 Years Through6 Years Of Age For Intramuscular Use |
| 90697-CPT | Low | Dtap Ipv Hib Hepb Vaccine Im, Diphtheria Tetanus Toxoids Acellular Pertussis Vaccine Inactivated Poliovirus Vaccine Haemophilus Influenzae Type B Prp Omp Conjugate Vaccine And Hepatitis B Vaccine Dtap Ipv Hib Hepb For Intramuscular Use |
| 90700-CPT | Low | Dtap Vaccine Solution, A Dtap Solution Prepared For Vaccination Of A Child Up To Age 7. The Solution Is Intended To Protect Against Diphtheria Tetanus And Whooping Cough (Pertussis). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90696. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90696 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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