CPT 91304 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 • COVID-19 Vaccines/Toxoids |
| Common Place of Service | • 60 - Mass Immunization Center • 11 - Office |
| Common Modifiers | • None • SL • GW - Condition not related to the patient's terminal condition |
| Complexity Level | Low |
National average reimbursement for CPT 91304 by major payers:
$146.06
$158.74
$156.69
$208.43
| 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 91304 | ||||||
United | 91304 | $143.00 | 1760412621 - RHONDA LAMPEN | 911352172 - MULTICARE HEALTH SYSTEM | VA | Psychiatry Physician (2084P0800X) |
United | 91304 | $167.21 | 1871505230 - MICHAEL NAYLOR | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 91304 | $177.83 | 1780633271 - SHANNON SHI | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 91304 | $177.83 | 1093243149 - KRISTIN ROSSEAU | 362177139 - UNIVERSITY OF CHICAGO | CO | Psychiatry Physician (2084P0800X) |
United | 91304 | $164.64 | 1740201425 - JOSEPH DIVINCENZO | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 91304 | $156.00 | 1801897772 - BANKIMCHANDRA PATEL | 631171060 - (AL) NORTH ALABAMA CARDIOLOGY CENTER, P.C. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 91304 | $148.19 | 1922111657 - CLINT ANTHONY | 208106540 - DISTRICT MEDICAL GROUP INC | IL | Psychiatry Physician (2084P0800X) |
United | 91304 | $164.64 | 1740201425 - JOSEPH DIVINCENZO | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | WI | Psychiatry Physician (2084P0800X) |
United | 91304 | $194.25 | 1033328869 - LEAH USTAS | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 91304 | $194.25 | 1942650130 - MALIK NASSAN | 362679194 - (IL) HEAD & NECK AND COSMETIC SURGERY ASSOCIATES, LLC | MN | Psychiatry Physician (2084P0800X) |
United | 91304 | $177.83 | 1093243149 - KRISTIN ROSSEAU | 362177139 - UNIVERSITY OF CHICAGO | IL | Psychiatry Physician (2084P0800X) |
United | 91304 | $148.19 | 1962767376 - AMAN DEEP SINGH | 770460802 | IL | Psychiatry Physician (2084P0800X) |
United | 91304 | $174.88 | 1144420365 - ALMA RAMIC | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
United | 91304 | $156.00 | 1649355827 - BRIAN SNODDY | 631119002 - (AL) BIRMINGHAM HEART CLINIC, PC | AL | Interventional Cardiology Physician (207RI0011X) |
United | 91304 | $406.35 | 1245587765 - ZAKARIA ALMUWAQQAT | 582030692 - EMORY UNIVERSITY | 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 91304 vs. Other COVID-19 Vaccines/Toxoids Codes
The CPT 91304 code is part of the Medicine Services and Procedures services used for COVID-19 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 91304 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 |
|---|---|---|
| 91300-CPT | Low | Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease (Covid-19)) Vaccine, Mrna-Lnp, Spike Protein, Preservative Free, 30 Mcg/0.3 Ml Dosage, Diluent Reconstituted, For Intramuscular Use |
| 91302-CPT | Low | Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Dna, Spike Protein, Chimpanzee Adenovirus Oxford 1 (Chadox1) Vector, Preservative Free, 5x1010 Viral Particles/0.5ml Dosage, For Intramuscular Use |
| 91303-CPT | Low | Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease (Covid-19)) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5x1010 Viral Particles/0.5 Ml Dosage, For Intramuscular Use |
| 91304-CPT | Low | Severe Acute Respiratory Syndrome Coronavirus 2 Sars-Cov-2) (Coronavirus Disease [Covid-19]) Vaccine Recombinant Spike Protein Nanoparticle Saponin-Based Adjuvant 5 Mcg/0.5 Ml Dosage For Intramuscular Use (Desc Rsvd 9/11/2023) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 91304. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 91304 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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