90684 Medicare Reimbursement Rate (2026)
Current CMS pricing and breakdown for Medical Code Description.
National Average Payment
Non-Facility (Private Office) Rate
90684 Reimbursement Rate History
| Quarter | Q1 2025 | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | $327.89 | $327.89 | $327.89 | $327.89 | $344.25 | $344.25 |
ℹ️ Good to Know
This item has a standard price nationwide. Your local rate will likely match the amount shown above.
Code Description
Pneumococcal conjugate vaccine (PCV21) covering 21 pneumococcal serotypes, administered intramuscularly. A vaccine that protects against pneumococcal disease including pneumonia, meningitis, and bloodstream infections caused by Streptococcus pneumoniae bacteria.
Reimbursement Summary
CPT code 90684 (Pneumococcal conjugate vaccine (PCV21) covering 21 pneumococcal serotypes, administered intramuscularly. A vaccine that protects against pneumococcal disease including pneumonia, meningitis, and bloodstream infections caused by Streptococcus pneumoniae bacteria.) had a 2026 Medicare non-facility reimbursement rate of $344.25. This reflects a 4.99% change from the prior year.
The 2026 National Medicare reimbursement for 90684 is $344.25. This item is paid at a standard national rate, so local variation is typically minimal.
Description: Pneumococcal conjugate vaccine (PCV21) covering 21 pneumococcal serotypes, administered intramuscularly. A vaccine that protects against pneumococcal disease in.... Payment policies and coverage rules can still vary by setting and claim details, so confirm final guidance through CMS when needed.
90684 Reimbursement Rate History
| Quarter | Q1 2025 | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | $327.89 | $327.89 | $327.89 | $327.89 | $344.25 | $344.25 |
Historical Medicare Reimbursement
| Quarter | Non-Facility Rate | Facility Rate | YoY % Change (Non-Fac) | YoY % Change (Fac) |
|---|---|---|---|---|
| 2026 Q2 | $344.25 | $344.25 | +4.99% | +4.99% |
| 2026 Q1 | $344.25 | $344.25 | +4.99% | +4.99% |
| 2025 Q4 | $327.89 | $327.89 | — | — |
| 2025 Q3 | $327.89 | $327.89 | — | — |
| 2025 Q2 | $327.89 | $327.89 | — | — |
| 2025 Q1 | $327.89 | $327.89 | — | — |
Commercial Payer Rates for 90684
Pro FeatureNational average reimbursement from major commercial payers based on CMS Transparency in Coverage machine-readable files.
| Modifier | Place of Service | Avg. Rate | vs Medicare | Percentile Range |
|---|---|---|---|---|
| NULL | Office (11) | $91.46 | -4.0% | $80 — $104 |
| NULL | Telehealth (02) | $88.20 | -7.4% | $76 — $102 |
| NULL | Facility (21) | $79.31 | -15.6% | $68 — $95 |
| NULL | Outpatient Hospital (22) | $84.92 | -10.2% | $71 — $99 |
| NULL | Home (12) | $96.14 | +1.0% | $84 — $113 |
Unlock commercial payer rates
See how BCBS, United, Aetna, and Cigna compare to Medicare for every code — included in MedFeeSchedule Pro.
Source: CMS Transparency in Coverage machine-readable files (MRFs). Commercial rates reflect payer-published negotiated amounts and may not reflect individual contracted rates.
Get notified when commercial payer rates launch
We're building payer rate comparison into MedFeeSchedule Pro. Enter your email to get early access.
Facility vs. Non-Facility (Office) Payment
Facility vs. non-facility pricing most commonly applies to physician services paid under the RVU-based Physician Fee Schedule. For 90684 (Drug / Biological), the payment methodology may not include both facility and non-facility rates.
Q2 2026 Breakdown
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | ||
| Practice Expense (PE) | ||
| Malpractice (MP) | ||
| Total RVUs | 0.00 | 0.00 |
Learn How This Reimbursement Is Calculated
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
Frequently Asked Questions
What is the 2026 Medicare rate for 90684?
The 2026 National Average Medicare reimbursement rate for 90684 (Drug / Biological) is $344.25. This rate is effective as of January 1, 2026.
What is the description for code 90684?
Pneumococcal conjugate vaccine (PCV21) covering 21 pneumococcal serotypes, administered intramuscularly. A vaccine that protects against pneumococcal disease including pneumonia, meningitis, and bloodstream infections caused by Streptococcus pneumoniae bacteria.
Why do facility and non-facility payments differ for 90684?
Facility vs. non-facility differences usually apply to RVU-based physician services. 90684 may not use both facility and non-facility pricing depending on its payment methodology.
How can I find my local Medicare rate for 90684?
Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage to estimate your locality-adjusted reimbursement. Medicare payment can vary based on geographic adjustments (GPCI), place of service, and claim specifics.
Is 90684 covered by Medicare?
Coverage depends on medical necessity, setting, and Medicare policy. Some codes may be bundled, contractor-priced, or restricted. Verify final coverage guidance through CMS or your local MAC when applicable.
