How much does Medicare pay for CPT 90658?

Medicare allowed an average of $21.26 per service and paid $21.26 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $44.53, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 90658?

Influenza vaccine, trivalent, 0.5 ml dosage. It was billed 76,521 times to 76,374 Medicare beneficiaries by 1,934 providers in 2024.

Does 90658 pay differently in an office than a hospital?

Yes. The allowed amount averaged $21.26 in an office setting and $12.32 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 90658 most?

Internal Medicine, with 35,780 services from 803 clinicians. Next are Family Practice, Mass Immunizer Roster Biller, Nurse Practitioner.

CPT 90658

Influenza vaccine, trivalent, 0.5 ml dosage

$21.26Medicare-allowed amount per service, averaged across 76,521 services

Providers submitted

$44.53

Asking price, not received

Medicare allowed

$21.26

The fee schedule figure

Medicare paid

$21.26

Balance is patient coinsurance

Providers submitted an average of $44.53 for this code and Medicare allowed $21.26 — 2.1× 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 $21.26 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $21.26
Hospital / facility: $12.32

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 76,481 services were billed in an office setting and 40 in a facility.

Services: 76,521
Beneficiaries: 76,374
Providers billing it: 1,934
Total allowed: $1,626,836

What Medicare pays for CPT 90658

Across 76,521 services billed by 1,934 providers to 76,374 beneficiaries, Medicare allowed an average of $21.26 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 90658

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	35,780	35,710	$21.26	803
Family Practice	19,934	19,889	$21.23	536
Mass Immunizer Roster Biller	6,383	6,382	$21.36	171
Nurse Practitioner	3,700	3,694	$21.10	137
General Practice	2,336	2,327	$21.35	38
Pharmacy	2,058	2,056	$21.41	56
Physician Assistant	1,029	1,027	$21.19	39
Cardiology	880	877	$21.40	30
Rheumatology	612	611	$21.42	16
Public Health or Welfare Agency	563	563	$20.33	12
Pulmonary Disease	542	542	$21.42	18
Endocrinology	445	442	$21.39	5
Allergy/ Immunology	301	298	$21.35	8
Emergency Medicine	276	275	$21.34	6
Hematology-Oncology	255	255	$21.25	13

90658 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
California	14,464	$21.35	$21.39	317
New York	12,066	$21.27	$21.31	297
New Jersey	5,550	$21.28	$21.32	147
Texas	4,573	$21.30	$21.37	128
Florida	3,466	$21.12	$21.14	81
Michigan	2,615	$21.27	$21.37	73
Maryland	2,534	$21.18	$21.24	55
Illinois	2,419	$21.33	$21.40	57
Virginia	2,322	$21.16	$21.27	51
Pennsylvania	2,235	$21.36	$21.42	52
Tennessee	2,223	$21.28	$21.37	55
Massachusetts	2,207	$21.29	$21.41	75
Louisiana	1,751	$21.31	$21.42	36
North Carolina	1,653	$20.94	$21.04	47
Ohio	1,640	$21.22	$21.36	45
Oklahoma	1,308	$21.33	$21.38	36
Arkansas	1,208	$20.87	$20.93	33
Alabama	1,178	$21.29	$21.42	36
Georgia	1,110	$21.31	$21.40	32
Arizona	1,078	$21.38	$21.41	22
Guam	1,061	$21.37	$21.39	18
Indiana	674	$21.29	$21.42	19
Mississippi	668	$20.67	$20.73	22
South Carolina	660	$21.39	$21.43	15
Missouri	656	$21.40	$21.40	21
Washington	541	$21.21	$21.26	21
Kansas	405	$21.37	$21.42	12
Kentucky	385	$21.36	$21.42	14
West Virginia	330	$21.23	$21.42	7
Oregon	325	$21.07	$21.21	9
Hawaii	323	$20.33	$20.67	9
Idaho	314	$21.35	$21.42	8
Wisconsin	302	$21.14	$21.21	7
Wyoming	284	$19.51	$19.51	7
Colorado	266	$21.42	$21.42	8
Utah	237	$20.21	$20.76	9
Connecticut	214	$21.42	$21.42	7
New Mexico	199	$21.31	$21.42	6
District of Columbia	198	$21.42	$21.42	3
Iowa	160	$21.42	$21.42	5
Nevada	150	$21.42	$21.42	6
Maine	126	$21.29	$21.29	4
U.S. Virgin Islands	85	$21.26	$21.26	3
Nebraska	84	$21.42	$21.42	5
Delaware	82	$21.42	$21.42	5
New Hampshire	65	$21.09	$21.43	2
North Dakota	52	$21.42	$21.42	2
Puerto Rico	49	$21.41	$21.41	3
Minnesota	26	$21.42	$21.42	2

Related codes

90662Influenza vaccine split virus$80.84
90653Influenza vaccine$81.38
90677Pneumococcal conjugate vaccine$287.84
90656Influenza vaccine$21.59
90673Influenza vaccine$75.77
90661Influenza vaccine$35.62
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.