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See a sample rate comparisonCPT 96381 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.
Rsv Vaccine, Respiratory Syncytial Virus (Rsv) Immune Globulin. Rsv Is An Infection That Causes Colds Coughs And Sometimes Pneumonia In Children And Infants.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration |
| Complexity Level | Low |
| Medicare Fee Schedule | $24.38 national non-facility rate (2026) · View Medicare rates for 96381 |
| Medicaid Fee Schedule | $19.65 median of the 7 states in the free preview · View Medicaid rates for 96381 |
National average reimbursement for CPT 96381 by major payers:
$24.98
$27.44
$N/A
$38.13
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CPT 96381
5 of 25 sample ratesHigher to lower in this preview
Neil Jariwala
$41.06Published rateJanice Kowalski
Edward Health Ventures
$32.58Published rateTeresa Sripada
The Board Of Trustees Of The University Of Illinois
$26.70Published rateCheriece Mcneely
Rosecrance Inc
$22.25Published rateThomas Herrmann
Hoopeston Community Memorial Hospital
$19.20Published rate
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See a sample payer proposalCPT 96381 vs. Other Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration Codes
The CPT 96381 code is part of the Medicine Services and Procedures services used for Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration. 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 96381 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 |
|---|---|---|
| 96381-CPT | Low | Rsv Vaccine, Respiratory Syncytial Virus (Rsv) Immune Globulin. Rsv Is An Infection That Causes Colds Coughs And Sometimes Pneumonia In Children And Infants. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96381. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96381 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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