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See a sample rate comparisonCPT 90716 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.
Chickenpox Vaccine Solution, A Live Chickenpox (Varicella Virus) Vaccine Solution Injected To Protect Against Infection.
| 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 90716 |
| Medicaid Fee Schedule | $171.495 median of the 8 states in the free preview · View Medicaid rates for 90716 |
National average reimbursement for CPT 90716 by major payers:
$185.01
$202.25
$209.10
$190.70
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CPT 90716
5 of 25 sample ratesHigher to lower in this preview
P. Daniel Le Grange
$399.45Published rateSanjay Nigam
Hshs Holy Family Hospital Inc
$219.41Published rateRitu Talwar
Horizons Behavioral Health LLC
$196.69Published rateMatthew Niedzwiecki
$183.00Published rateDa Pediatric Rehabilitation
$60.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 90716 vs. Other Vaccines, Toxoids Codes
The CPT 90716 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 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 |
| 90716-CPT | Low | Chickenpox Vaccine Solution, A Live Chickenpox (Varicella Virus) Vaccine Solution Injected To Protect Against Infection. |
| 90750-CPT | Low | Zoster (Shingles) Vaccine (Hzv) Recombinant Sub-Unit Adjuvanted For Intramuscular Injection (Reinstated 01/01/2017) Preventive Medicine Adult New Pt (Del 03/31/2003) |
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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