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See a sample rate comparisonCPT 91304 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.
Sarscov2 Vac 5mcg 0 5ml Im, Severe Acute Respiratory Syndrome Coronavirus 2 Sars Cov 2 Coronavirus Disease Covid 19 Vaccine Recombinant Spike Protein Nanoparticle Saponin Based Adjuvant Preservative Free 5 Mcg 0 5 Ml Dosage For Intramuscular Use
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Gastroenterology Procedures |
| Common Place of Service | 60 - Mass Immunization Center 11 - Office |
| Common Modifiers | SL GW - Condition not related to the patient's terminal condition |
| Complexity Level | Low |
| Medicare Fee Schedule | $232.22 per 1 dose (October 2026 ASP) · View Medicare rates for 91304 |
| Medicaid Fee Schedule | $179.545 median of the 8 states in the free preview · View Medicaid rates for 91304 |
National average reimbursement for CPT 91304 by major payers:
$146.06
$158.74
$156.69
$190.37
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CPT 91304
5 of 25 sample ratesHigher to lower in this preview
Stanley Thornton
Cardiology Associates Of Mobile, Inc.
$195.55Published rateErin Hurst
University Of Chicago
$177.83Published rateAliya Hafeez
Advocate Health And Hospitals Corporation
$159.28Published rateImran Khalil
Northeast Medical Group Inc
$148.19Published rateMohan Edupuganti
$133.89Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 91304 vs. Other Gastroenterology Procedures Codes
The CPT 91304 code is part of the Medicine Services and Procedures services used for Gastroenterology 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 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 |
|---|---|---|
| 91304-CPT | Low | Sarscov2 Vac 5mcg 0 5ml Im, Severe Acute Respiratory Syndrome Coronavirus 2 Sars Cov 2 Coronavirus Disease Covid 19 Vaccine Recombinant Spike Protein Nanoparticle Saponin Based Adjuvant Preservative Free 5 Mcg 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 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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