CPT 90696 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 | Low |
National average reimbursement for CPT 90696 by major payers:
$69.49
$68.81
$74.24
$77.79
| 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 | 1689787426 - KAREN SEVERSON | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | MT | Psychiatry Physician (2084P0800X) |
United | 90696 | $69.87 | 1093164238 - MARTIN GREENWALD | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 90696 | $61.83 | 1114196995 - ANGELA GREEN | 910844563 | LA | Psychiatry Physician (2084P0800X) |
United | 90696 | $133.21 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 90696 | $72.69 | 1881012235 - LAUREN PREST | 910843135 | IL | Psychiatry Physician (2084P0800X) |
United | 90696 | $61.83 | 1679526784 - ELTON SMITH | 910844563 | VA | Psychiatry Physician (2084P0800X) |
United | 90696 | $69.25 | 1669598421 - CHANDRIKA SHANKAR | 911780160 | NY | Psychiatry Physician (2084P0800X) |
United | 90696 | $72.95 | 1609296714 - JOHN ZULUETA | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 90696 | $75.63 | 1265753867 - ASIFA CHOUDHRY | 850703768 - (IL) CARLE WEST PHYSICIAN GROUP INC | IL | Psychiatry Physician (2084P0800X) |
United | 90696 | $72.69 | 1053725994 - HANS HENRIQUEZ | 363950044 - PROGRESSIVE MEDICAL CENTER, S.C. | IL | Internal Medicine Physician (207R00000X) |
United | 90696 | $61.83 | 1730263617 - MARK ALTER | 910844563 | VA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90696 | $70.08 | 1609023068 - LAURA MURPHY | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90696 | $72.95 | 1144203753 - HAIDAR KABBANI | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90696 | $68.69 | 1033347125 - DAVID HANRAHAN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | VA | Psychiatry Physician (2084P0800X) |
United | 90696 | $61.83 | 1629046735 - AQEEL KHAN | 363330928 - (IL) PRESENCE HEALTHCARE SERVICES | CT | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
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-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 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-CPT | 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-CPT | 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 90696) and we'll show you how you compare in 15 minutes or less.