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 | $148.19 | 1437129152 - DAVID DRENNING | 812971996 - (AL) HH HEART CENTER LLC | AL | Interventional Cardiology Physician (207RI0011X) |
United | 91304 | $179.49 | 1467802108 - MIRIAM BALTUANO SONGHURST | 863284696 - OU HEALTH PARTNERS INC | OK | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 91304 | $159.28 | 1437298361 - ALIYA HAFEEZ | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 91304 | $133.89 | 1164737490 - MOHAN EDUPUGANTI | 731321032 | MO | Interventional Cardiology Physician (207RI0011X) |
United | 91304 | $194.25 | 1215968755 - STACEY OCCOMY | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IN | Psychiatry Physician (2084P0800X) |
United | 91304 | $180.38 | 1386601136 - GARY ROUBIN | 1386601136 - (AL) GARY ROUBIN | AL | Interventional Cardiology Physician (207RI0011X) |
United | 91304 | $194.25 | 1033328869 - LEAH USTAS | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 91304 | $170.03 | 1164478178 - BRIAN DEARING | 630889615 - (AL) CARDIOLOGY ASSOCIATES OF MOBILE, INC. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 91304 | $148.19 | 1225211600 - JOHN MILLICHAP | 262037695 - GRADY MEMORIAL HOSPITAL CORPORATION | NC | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 91304 | $177.83 | 1578603593 - ERIN HURST | 362177139 - UNIVERSITY OF CHICAGO | IL | Psychiatry Physician (2084P0800X) |
United | 91304 | $137.44 | 1487867172 - TAIMOOR HASHIM | 630888599 - (AL) SOUTHEASTERN CARDIOLOGY CONSULTANTS, P.C. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 91304 | $156.00 | 1619923844 - CRAIG PETERSON | 631220236 - (AL) EASTERN SHORE HEART CENTER | AL | Interventional Cardiology Physician (207RI0011X) |
United | 91304 | $141.69 | 1982638383 - HENRY FLEMMING | 630691533 - (AL) MONTGOMERY CARDIOVASCULAR ASSOCIATES, P.C. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 91304 | $165.10 | 1447372842 - GEOFFREY LEVIN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 91304 | $148.19 | 1750351169 - HENRY CHEN | 823333903 - HUNTSVILLE HOSPITAL PROFESSIONAL SERVICES | 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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