Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 90738 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.
Japanese Encephalitis Vaccine, A Vaccine Solution For Japanese Encephalitis. The Illness Is Spread By The Bite Of Infected Mosquitoes And Can Cause The Brain To Swell.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Vaccines, Toxoids |
| Common Place of Service | 11 - Office 71 - Public Health Clinic |
| Common Modifiers | GA - Required ABN issued and on file GY - Notice of Liability Not Issued, Not Required Under Payer Policy. |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 90738 |
| Medicaid Fee Schedule | $295.03 median of the 8 states in the free preview · View Medicaid rates for 90738 |
National average reimbursement for CPT 90738 by major payers:
$280.63
$305.35
$317.28
$325.46
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 90738.
CPT 90738
5 of 25 sample ratesHigher to lower in this preview
Maya Cloyd
Indiana University Health Southern Indiana Physicians
$400.19Published ratePhilip Janicak
Edward Health Ventures
$335.35Published rateAsifa Choudhry
Carle West Physician Group Inc
$315.79Published ratePaul Berkowitz
Presence Healthcare Services
$279.45Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$251.51Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 90738 vs. Other Vaccines, Toxoids Codes
The CPT 90738 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 90738 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 |
|---|---|---|
| 90717-CPT | Low | Immunization, Active; Yellow Fever |
| 90733-CPT | Low | Meningitis Vaccine Solution, Meningococcal Vaccine Solution. The Vaccine Is Given To Prevent Infection With The Meningococcus Bacteria Which Can Cause Meningitis (Infection In The Tissue Surrounding The Brain) And Other Serious Infections. |
| 90734-CPT | Low | Meningitis Vaccine Solution, Meningococcal Vaccine Solution. The Vaccine Is Given To Prevent Infection With The Meningococcus Bacteria Which Can Cause Meningitis (Infection In The Tissue Surrounding The Brain) And Other Serious Infections. |
| 90738-CPT | Moderate | Japanese Encephalitis Vaccine, A Vaccine Solution For Japanese Encephalitis. The Illness Is Spread By The Bite Of Infected Mosquitoes And Can Cause The Brain To Swell. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90738. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90738 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 90738) and we'll show you how you compare in 15 minutes or less.