CPT 90698 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 | Moderate |
National average reimbursement for CPT 90698 by major payers:
$115.51
$126.76
$136.70
$128.27
| 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 90698 | ||||||
United | 90698 | $129.41 | 1679739395 - BETSY OSTRANDER | 810232124 - SCL HEALTH MONTANA | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90698 | $134.03 | 1992961643 - CYNTHIA GORDON | 815174138 - (IL) ILLINOIS PROFESSIONALS HEALTH PROGR | IL | Psychiatry Physician (2084P0800X) |
United | 90698 | $131.66 | 1225211600 - JOHN MILLICHAP | 753186720 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90698 | $114.51 | 1245252303 - MARY FAHRMEIER | 910844563 | VA | Psychiatry Physician (2084P0800X) |
United | 90698 | $126.79 | 1710061486 - DAVID KEMP | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90698 | $161.83 | 1134127301 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 90698 | $161.83 | 1851390637 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 90698 | $111.91 | 1972501252 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 90698 | $157.69 | 1073042727 - SHAWN KACKER | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90698 | $60.00 | 1801164967 - DA PEDIATRIC REHABILITATION | 270939565 - (FL) DA PEDIATRIC REHABILITATION | FL | Home Health Agency (251E00000X) |
United | 90698 | $114.51 | 1225211600 - JOHN MILLICHAP | 454158203 - COMMUNITY CARE NETWORK INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90698 | $200.41 | 1851490791 - TANYA ROYSTER | 371206525 - QUINCY PHYSICIANS & SURGEONS CLINIC S.C. D/B/A QUINCY MEDICAL GROUP | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90698 | $137.41 | 1285719260 - TANMOY CHANDRA | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Psychiatry Physician (2084P0800X) |
United | 90698 | $131.66 | 1215968755 - STACEY OCCOMY | 611630276 - FRANCISCAN PHYSICIAN NETWORK | IN | Psychiatry Physician (2084P0800X) |
United | 90698 | $131.66 | 1679515951 - EUGENE SCHNITZLER | 364035455 | IL | 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 90698 vs. Other Vaccines, Toxoids Codes
The CPT 90698 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 90698 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 90698. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90698 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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