CPT 91318 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 |
| Complexity Level | Moderate |
National average reimbursement for CPT 91318 by major payers:
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| 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 91318 | ||||||
United | 91318 | $55.72 | 1710969001 - LYNELLE THOMAS | 911780160 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 91318 | $75.90 | 1386969079 - ADAM WALLACE | 363907436 - ROCKFORD HEALTH PHYSICIANS | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 91318 | $67.84 | 1922010230 - STEVAN WEINE | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 91318 | $109.25 | 1972543080 - HOSSAM ABDELSALAM | 364143823 - SIU PHYSICIANS & SURGEONS INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 91318 | $73.41 | 1477181071 - KEVIN VARGHESE | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 91318 | $57.50 | 1225211600 - JOHN MILLICHAP | 262037695 - GRADY MEMORIAL HOSPITAL CORPORATION | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 91318 | $85.91 | 1033435557 - JESSICA NICHOLSON | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 91318 | $57.50 | 1548271018 - MING XU | 363330928 - (IL) PRESENCE HEALTHCARE SERVICES | IL | Psychiatry Physician (2084P0800X) |
United | 91318 | $63.88 | 1033347125 - DAVID HANRAHAN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | MN | Psychiatry Physician (2084P0800X) |
United | 91318 | $79.38 | 1467802108 - MIRIAM BALTUANO SONGHURST | 863284696 - OU HEALTH PARTNERS INC | OK | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 91318 | $63.25 | 1659996767 - BLUESKY TELEPSYCH | 851408702 - BLUESKY TELEPSYCH | IL | Psychiatry Physician (2084P0800X) |
United | 91318 | $77.34 | 1811068554 - JAMES MACKENZIE | 205547757 - (IL) LURIE CHILDRENS MEDICAL GROUP LLC | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 91318 | $67.84 | 1891921367 - KAVITA THAKKAR | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 91318 | $57.50 | 1871907774 - ODAY ALSARRAF | 362222696 - SWEDISHAMERICAN HOSPITAL | IL | Psychiatry Physician (2084P0800X) |
United | 91318 | $78.79 | 1942330576 - NASIR SYED | 862358048 - (IL) INSIGHT CHICAGO INC | IL | Psychiatry Physician (2084P0800X) |
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 91318 vs. Other COVID-19 Vaccines/Toxoids Codes
The CPT 91318 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 91318 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 |
|---|---|---|
| 91318-CPT | Moderate | Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]) Vaccine, Mrna-Lnp, Spike Protein, 3 Mcg/0.3 Ml Dosage, Diluent Reconstituted, Tris-Sucrose Formulation, 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 91318. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 91318 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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