CPT 90716 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 | Vaccines, Toxoids Medicine Services and Procedures |
| 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 |
| Medicare Fee Schedule | View Medicare rates for 90716 |
National average reimbursement for CPT 90716 by major payers:
$185.01
$202.25
$209.10
$190.70
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 90716 | $183.00 | 1154749844 - NORA EKEANYA | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 90716 | $219.60 | 1215258876 - DARA PUMPHREY-RUIZ | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Psychiatry Physician (2084P0800X) |
United | 90716 | $219.41 | 1942278973 - SANJAY NIGAM | 370792770 - (IL) HSHS HOLY FAMILY HOSPITAL INC | IL | Psychiatry Physician (2084P0800X) |
United | 90716 | $196.69 | 1518124932 - RITU TALWAR | 363994258 - (IL) HORIZONS BEHAVIORAL HEALTH LLC | IL | Psychiatry Physician (2084P0800X) |
United | 90716 | $215.94 | 1497767719 - ELIZABETH CHARNEY | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90716 | $399.45 | 1760502058 - P. DANIEL LE GRANGE | 943281657 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90716 | $196.69 | 1831432343 - JOHN MCMILLIN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90716 | $239.86 | 1104993161 - BETH LEDVORA | 463010946 - (IL) BETH LEDVORA M.D., S.C. | IL | Psychiatry Physician (2084P0800X) |
United | 90716 | $183.00 | 1881918415 - TUSHAR ADVANI | 910844563 | MT | Psychiatry Physician (2084P0800X) |
United | 90716 | $233.59 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 90716 | $183.00 | 1962664789 - JAMIE EVANS | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 90716 | $209.04 | 1780694620 - CARSON MEDICAL GROUP PROFESSIONAL CORPORATION | 880133501 - CARSON MEDICAL GROUP | NV | Obstetrics & Gynecology Physician (207V00000X) |
United | 90716 | $156.90 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 90716 | $204.96 | 1508986308 - COREY GOLDSTEIN | 911779996 - (IL) RUSH UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 90716 | $239.86 | 1992961643 - CYNTHIA GORDON | 815174138 - (IL) ILLINOIS PROFESSIONALS HEALTH PROGR | 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 90716 vs. Other Medicine Services and Procedures Codes
The CPT 90716 code is part of the Vaccines, Toxoids services used for Medicine Services and Procedures. 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 90716 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 |
|---|---|---|
| 90396-CPT | High | Solution To Prevent Chickenpox, An Antibody Substance (Gamma Globulin Or Immune Globulin) That Helps To Prevent Infection By The Virus That Causes Chickenpox. This Solution Is Given By Shot. |
| 90471-CPT | Low | Immunization Administration (I, Immunization Administration (Includes Percutaneousintradermal Subcutaneous Intramuscular And Jet Injections Andor Intranasal Or Oral Administration) Single Or |
| 90710-CPT | Moderate | Mmrv Vaccine Solution, The Mmrv Is A Live Vaccine Solution Containing Measles Mumps Rubella (German Measles) And Varicella (Chickenpox). The Vaccine Is Given To Protect Against Infection. |
| 90716-CPT | Low | Chickenpox Vaccine Solution, A Live Chickenpox (Varicella Virus) Vaccine Solution Injected To Protect Against Infection. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90716. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90716 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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