How much does Medicare pay for CPT 90686?

Medicare allowed an average of $21.65 per service and paid $21.65 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $32.14, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 90686?

Influenza vaccine, quadrivalent, preservative free, 0.5 ml dosage. It was billed 15,481 times to 15,432 Medicare beneficiaries by 268 providers in 2024.

Which specialty bills 90686 most?

Centralized Flu, with 10,134 services from 20 clinicians. Next are Internal Medicine, Family Practice, Mass Immunizer Roster Biller.

CPT 90686

Influenza vaccine, quadrivalent, preservative free, 0.5 ml dosage

$21.65Medicare-allowed amount per service, averaged across 15,481 services

Providers submitted

$32.14

Asking price, not received

Medicare allowed

$21.65

The fee schedule figure

Medicare paid

$21.65

Balance is patient coinsurance

Providers submitted an average of $32.14 for this code and Medicare allowed $21.65 — 1.5× 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 $21.65 (100%); the rest is the patient’s coinsurance and deductible.

Services: 15,481
Beneficiaries: 15,432
Providers billing it: 268
Total allowed: $335,164

What Medicare pays for CPT 90686

Across 15,481 services billed by 268 providers to 15,432 beneficiaries, Medicare allowed an average of $21.65 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 90686

Specialty	Services	Beneficiaries	Avg allowed	Providers
Centralized Flu	10,134	10,131	$21.88	20
Internal Medicine	1,761	1,725	$21.07	65
Family Practice	1,585	1,577	$20.93	75
Mass Immunizer Roster Biller	1,237	1,236	$21.57	69
Nurse Practitioner	200	199	$21.90	13
Infectious Disease	158	158	$20.54	3
Pharmacy	144	144	$21.88	9
Nephrology	47	47	$21.43	1
Public Health or Welfare Agency	40	40	$21.90	2
Medical Oncology	36	36	$21.90	2
General Practice	33	33	$21.90	2
Obstetrics & Gynecology	28	28	$21.86	2
Pediatric Medicine	20	20	$21.90	1
Endocrinology	19	19	$21.90	1
Cardiology	14	14	$21.90	1

90686 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
Idaho	7,443	$21.90	$21.90	12
Florida	1,771	$21.86	$21.89	18
Ohio	1,258	$21.81	$21.88	27
Colorado	665	$21.58	$21.58	5
California	658	$20.45	$20.45	31
Texas	571	$21.82	$21.90	19
Kentucky	343	$21.39	$21.91	11
Washington	241	$21.90	$21.90	8
Oklahoma	226	$21.02	$21.02	2
Mississippi	168	$16.88	$17.06	12
Arkansas	166	$20.61	$20.61	7
Illinois	160	$21.90	$21.90	12
Maryland	134	$21.90	$21.90	10
New York	123	$21.90	$21.90	7
North Carolina	121	$21.86	$21.86	8
New Jersey	113	$21.89	$21.89	4
Alaska	110	$21.90	$21.90	1
Louisiana	102	$21.69	$21.90	5
Virginia	87	$20.01	$20.47	7
Indiana	82	$21.37	$21.91	6
Arizona	75	$21.90	$21.90	5
Missouri	75	$21.90	$21.90	3
Wisconsin	72	$20.18	$20.18	2
Utah	61	$21.90	$21.90	5
Minnesota	56	$21.90	$21.90	2
Tennessee	52	$21.90	$21.90	4
Pennsylvania	49	$21.90	$21.90	2
South Carolina	49	$21.45	$21.91	3
Wyoming	47	$17.56	$17.56	4
U.S. Virgin Islands	47	$21.43	$21.91	1
Oregon	46	$21.90	$21.90	3
Georgia	45	$21.90	$21.90	3
Nevada	45	$21.90	$21.90	3
Delaware	28	$21.90	$21.90	2
Alabama	27	$21.09	$21.92	2
New Hampshire	24	$21.90	$21.90	2
Nebraska	24	$21.90	$21.90	2
Northern Mariana Islands	20	$2.03	$2.03	1
Iowa	19	$21.90	$21.90	1
Massachusetts	19	$21.90	$21.90	1
West Virginia	14	$21.90	$21.90	1
North Dakota	12	$21.71	$21.71	1
Hawaii	11	$19.91	$21.94	1
Michigan	11	$21.90	$21.90	1
Guam	11	$21.90	$21.90	1

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
90658Influenza vaccine$21.26
90694Influenza vaccine$74.67
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.