CPT 90756 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 • 60 - Mass Immunization Center |
| Common Modifiers | • None • 59 - Distinct Procedural Service • SL |
| Complexity Level | Moderate |
National average reimbursement for CPT 90756 by major payers:
$33.94
$36.46
$34.52
$42.54
| 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 90756 | ||||||
United | 90756 | $41.88 | 1851390637 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 90756 | $34.08 | 1245252303 - MARY FAHRMEIER | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 90756 | $38.84 | 1699752204 - CATHERINE CAMILLERI | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Psychiatry Physician (2084P0800X) |
United | 90756 | $32.36 | 1114196995 - ANGELA GREEN | 910844563 | LA | Psychiatry Physician (2084P0800X) |
United | 90756 | $37.86 | 1407807746 - SYED KHAN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 90756 | $38.50 | 1063905339 - KATHRYN ABELL | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | DC | Psychiatry Physician (2084P0800X) |
United | 90756 | $32.36 | 1760461867 - RITA YADAVA | 363878197 - (IL) RITA YADAVA MDSC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90756 | $34.08 | 1154856607 - SHUBHADA REDDY | 756004221 - DALLAS COUNTY HOSPITAL DISTRICT | IL | Psychiatry Physician (2084P0800X) |
United | 90756 | $35.95 | 1366883555 - DAVID BANAYAN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 90756 | $37.49 | 1740252972 - DAVID HSU | 362222696 - SWEDISHAMERICAN HOSPITAL | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90756 | $35.95 | 1235440058 - CAROLYN DOYLE | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | CA | Psychiatry Physician (2084P0800X) |
United | 90756 | $32.36 | 1972543080 - HOSSAM ABDELSALAM | 363978153 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90756 | $33.63 | 1245466267 - JOSEPH KIPTA | 912151670 - STRAUB CLINIC & HOSPITAL | IL | Psychiatry Physician (2084P0800X) |
United | 90756 | $40.20 | 1891921367 - KAVITA THAKKAR | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | PA | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90756 | $34.08 | 1407810013 - LOVDIE LEWIS | 636000271 - (AL) THE DCH HEALTH CARE AUTHORITY | AL | Interventional Cardiology Physician (207RI0011X) |
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 90756 vs. Other Vaccines, Toxoids Codes
The CPT 90756 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 90756 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 |
|---|---|---|
| 90702 | Low | Diphtheria And Tetanus Toxoids Adsorbed (Dt) When Administered To Individuals Younger Than 7 Years For Intramuscular Use (Desc Revised 7/1/2015) |
| 90717 | Low | Immunization, Active; Yellow Fever |
| 90732 | Low | Pneumococcal Polysaccharide Vaccine 23-Valent (Ppsv23) Adult Or Immunosuppressed Patient Dosage When Administered To Individuals 2 Years Or Older For Subcutaneous Or Intramuscular Use (Desc Revised 7/1/2015) |
| 90756 | Low | Influenza Virus Vaccine, Quadrivalent (Cciiv4), Derived From Cell Cultures, Subunit, Antibiotic Free, 0.5 Ml Dosage, For Intramuscular Use |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90756. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90756 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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