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See a sample rate comparisonHCPCS G9416 Fee Schedule
Last Verified: September 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.
Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (TDAP) on or between the patient's 10th and 13th birthdays
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Additional Assorted Quality Measures |
| Complexity Level | Low |
National average reimbursement for HCPCS G9416 by major payers:
$71.02
$51.00
$0.01
$1.16
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HCPCS G9416
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See a sample payer proposalHCPCS G9416 vs. Other Additional Assorted Quality Measures Codes
The HCPCS G9416 code is part of the Procedures / Professional Services services used for Additional Assorted Quality Measures. 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 HCPCS G9416 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 |
|---|---|---|
| G9415-HCPCS | Low | Patient did not have one dose of meningococcal vaccine (serogroups a, c, w, y or a, c, w, y, b), on or between the patient's 10th and 13th birthdays |
| G9416-HCPCS | Low | Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (TDAP) on or between the patient's 10th and 13th birthdays |
| G9417-HCPCS | Low | Patient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (TDAP) on or between the patient's 10th and 13th birthdays |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G9416. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G9416 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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