How much does Medicare pay for CPT 90656?

Medicare allowed an average of $21.59 per service and paid $21.59 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $37.53, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 90656?

Influenza vaccine, trivalent, split virus, preservative-free, 0.5 ml dosage. It was billed 260,591 times to 260,247 Medicare beneficiaries by 7,625 providers in 2024.

Does 90656 pay differently in an office than a hospital?

Yes. The allowed amount averaged $21.59 in an office setting and $21.89 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 90656 most?

Mass Immunizer Roster Biller, with 61,000 services from 2,422 clinicians. Next are Family Practice, Internal Medicine, Centralized Flu.

CPT 90656

Influenza vaccine, trivalent, split virus, preservative-free, 0.5 ml dosage

$21.59Medicare-allowed amount per service, averaged across 260,591 services

Providers submitted

$37.53

Asking price, not received

Medicare allowed

$21.59

The fee schedule figure

Medicare paid

$21.59

Balance is patient coinsurance

Providers submitted an average of $37.53 for this code and Medicare allowed $21.59 — 1.7× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $21.59 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $21.59
Hospital / facility: $21.89

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 260,516 services were billed in an office setting and 75 in a facility.

Services: 260,591
Beneficiaries: 260,247
Providers billing it: 7,625
Total allowed: $5,626,160

What Medicare pays for CPT 90656

Across 260,591 services billed by 7,625 providers to 260,247 beneficiaries, Medicare allowed an average of $21.59 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

This is a drug or supply code rather than a service. The unit is usually a dose or a milligram, so the per-service figure is small by construction and the total is what carries meaning — read it alongside the service count rather than on its own.

Who bills 90656

Specialty	Services	Beneficiaries	Avg allowed	Providers
Mass Immunizer Roster Biller	61,000	60,998	$21.82	2,422
Family Practice	55,219	55,135	$21.17	1,632
Internal Medicine	54,994	54,826	$21.56	1,348
Centralized Flu	43,905	43,860	$21.90	867
Pharmacy	15,954	15,948	$21.89	378
Nurse Practitioner	13,431	13,415	$21.16	519
Physician Assistant	2,580	2,579	$21.41	130
Pediatric Medicine	2,240	2,239	$21.89	17
General Practice	1,524	1,517	$21.30	52
Public Health or Welfare Agency	1,468	1,468	$20.72	43
Infectious Disease	1,458	1,458	$21.62	12
Cardiology	1,149	1,146	$21.85	23
Pulmonary Disease	1,074	1,073	$21.69	24
Clinical Laboratory	714	714	$21.78	19
Geriatric Medicine	635	629	$21.60	10

90656 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	33,266	$21.85	$21.87	308
California	30,713	$21.80	$21.84	916
New York	17,393	$21.79	$21.84	660
Texas	13,289	$21.76	$21.84	366
Illinois	12,563	$21.80	$21.87	338
Massachusetts	9,419	$21.78	$21.81	405
New Jersey	8,726	$21.81	$21.87	330
Mississippi	8,069	$17.21	$17.35	171
Maryland	8,016	$21.60	$21.70	281
North Carolina	6,930	$21.53	$21.63	246
Colorado	6,477	$21.89	$21.89	68
Pennsylvania	6,106	$21.71	$21.84	289
Tennessee	5,514	$21.67	$21.90	171
Washington	4,865	$21.89	$21.90	118
Georgia	4,783	$21.56	$21.89	140
Ohio	4,678	$21.77	$21.88	175
Arizona	4,490	$21.78	$21.87	104
Missouri	4,350	$21.85	$21.92	134
Michigan	4,171	$21.52	$21.68	170
Virginia	4,155	$21.40	$21.50	127
Minnesota	4,097	$21.86	$21.88	154
Indiana	4,060	$21.60	$21.70	115
Wisconsin	4,034	$21.66	$21.81	170
Louisiana	3,951	$21.78	$21.86	99
Arkansas	3,776	$21.81	$21.88	107
South Carolina	3,758	$21.80	$21.84	95
Iowa	3,392	$21.82	$21.88	155
Idaho	3,050	$21.82	$21.82	53
Connecticut	2,809	$21.86	$21.89	123
Oklahoma	2,696	$21.22	$21.34	84
Kentucky	2,613	$21.62	$21.83	85
Delaware	2,308	$21.82	$21.90	57
Alabama	2,221	$21.24	$21.39	81
Oregon	2,136	$21.39	$21.47	92
Kansas	1,854	$21.27	$21.28	69
Nebraska	1,809	$21.77	$21.86	55
Wyoming	1,605	$20.26	$20.29	44
South Dakota	1,516	$21.89	$21.90	41
West Virginia	1,513	$21.84	$21.86	58
New Mexico	1,508	$21.72	$21.87	52
Utah	1,386	$21.82	$21.84	29
New Hampshire	1,117	$21.84	$21.90	63
North Dakota	989	$21.85	$21.85	35
Montana	887	$21.26	$21.31	36
Vermont	771	$21.90	$21.90	37
Maine	738	$21.90	$21.90	31
Nevada	638	$21.76	$21.90	37
Hawaii	501	$20.91	$21.35	18
Guam	185	$21.54	$21.90	2
Rhode Island	166	$11.71	$11.71	10
Puerto Rico	140	$20.59	$20.59	5
District of Columbia	124	$21.87	$21.87	7
Alaska	109	$21.90	$21.90	6
Northern Mariana Islands	83	$21.90	$21.90	1
U.S. Virgin Islands	78	$21.06	$21.92	2

Related codes

90662Influenza vaccine split virus$80.84
90653Influenza vaccine$81.38
90677Pneumococcal conjugate vaccine$287.84
90673Influenza vaccine$75.77
90661Influenza vaccine$35.62
90658Influenza vaccine$21.26
90694Influenza vaccine$74.67
90686Influenza vaccine$21.65
90684Pcv21 vaccine im$319.79
90671Pneumococcal conjugate vaccine$246.27
90688Influenza vaccine$20.25
90674Influenza vaccine$32.86

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.