CPT 90696 Fee Schedule

Last Verified: November 2025

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 Acellular Pertussis Vaccine And Inactivated Poliovirus Vaccine (Dtap-Ipv) When Administered To Children 4 Through 6 Years Of Age For Intramuscular Use (Desc Revised 7/1/2015)

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 90696 by major payers:

$69.49

$68.81

$74.24

$77.79

Preview provider-level rates for...

For billing codeCPT 90696

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 90696
United	90696	$68.69	1679515951 - EUGENE SCHNITZLER	364015560 - LOYOLA UNIVERSITY MEDICAL CENTER	IL	Neurology with Special Qualifications in Child Neurology Physician (2084N0402X)
United	90696	$72.95	1043522899 - SHARAD KOIRALA	363305449 - (IL) MOUNT SINAI COMMUNITY FOUNDATION	IL	Child & Adolescent Psychiatry Physician (2084P0804X)
United	90696	$72.69	1881012235 - LAUREN PREST	910843135	IL	Psychiatry Physician (2084P0800X)
United	90696	$68.69	1740201425 - JOSEPH DIVINCENZO	364015560 - LOYOLA UNIVERSITY MEDICAL CENTER	PA	Psychiatry Physician (2084P0800X)
United	90696	$68.69	1407807746 - SYED KHAN	364015560 - LOYOLA UNIVERSITY MEDICAL CENTER	IN	Psychiatry Physician (2084P0800X)
United	90696	$67.62	1497080584 - ELIZABETH HOMAN	362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION	IA	Psychiatry Physician (2084P0800X)
United	90696	$76.84	1629181037 - DUKE RUKTANONCHAI	742958277 - SCOTT & WHITE CLINIC	PA	Psychiatry Physician (2084P0800X)
United	90696	$61.83	1609883347 - BRAD BERGER	362709982 - (IL) PRESENCE BEHAVIORAL HEALTH	IL	Child & Adolescent Psychiatry Physician (2084P0804X)
United	90696	$61.83	1730263617 - MARK ALTER	910844563	CA	Child & Adolescent Psychiatry Physician (2084P0804X)
United	90696	$61.83	1730263617 - MARK ALTER	910844563	WI	Child & Adolescent Psychiatry Physician (2084P0804X)
United	90696	$61.83	1225211600 - JOHN MILLICHAP	262037695 - GRADY MEMORIAL HOSPITAL CORPORATION	CO	Neurology with Special Qualifications in Child Neurology Physician (2084N0402X)
United	90696	$82.45	1104993161 - BETH LEDVORA	463010946 - (IL) BETH LEDVORA M.D., S.C.	IL	Psychiatry Physician (2084P0800X)
United	90696	$61.83	1275564197 - PAUL BERKOWITZ	363330928 - (IL) PRESENCE HEALTHCARE SERVICES	FL	Psychiatry Physician (2084P0800X)
United	90696	$84.11	1699713347 - PAULA GEWARGES	362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION	IL	Child & Adolescent Psychiatry Physician (2084P0804X)
United	90696	$54.27	1265883375 - JOCELYN LORENZO	274026658	LA	Neurology with Special Qualifications in Child Neurology Physician (2084N0402X)
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 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	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	Low	Diphtheria Tetanus Toxoids Acellular Pertussis Vaccine And Inactivated Poliovirus Vaccine (Dtap-Ipv) When Administered To Children 4 Through 6 Years Of Age For Intramuscular Use (Desc Revised 7/1/2015)
90697	Low	Diphtheria Tetanus Toxoids Acellular Pertussis Vaccine Inactivated Poliovirus Vaccine Haemophilus Influenza Type B Prp-Omp Conjugate Vaccine And Hepatitis B Vaccine (Dtap-Ipv-Hib- Hepb) For Intramuscular Use
90698	Low	Diphtheria Tetanus Toxoids Acellular Pertussis Vaccine Haemophilus Influenzae Type B Inactivated Poliovirus Vaccine (Dtap-Ipv/Hib) For Intramuscular Use (Desc Revised 7/1/2015)

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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