90685 Medicare Reimbursement Rate (2026)
Current CMS pricing and breakdown for Iiv4 vacc no prsv 0.25 ml im.
National Average Payment
Non-Facility (Private Office) Rate
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Code Description
Iiv4 vacc no prsv 0.25 ml im
Reimbursement Summary
90685 is a CPT code in the category “Physician Service.” Medicare does not publish a single national payment amount for this code in 2026 (Not Covered). This code is excluded/invalid for Medicare.
Because this code is not covered/invalid for Medicare, a reimbursement rate is not expected under Medicare rules. If you believe this should be payable, verify directly with CMS or your MAC.
Historical Medicare Reimbursement
| Quarter | Non-Facility Rate | Facility Rate | YoY % Change (Non-Fac) | YoY % Change (Fac) |
|---|---|---|---|---|
| 2026 Q2 | $0.00 | $0.00 | — | — |
| 2026 Q1 | $0.00 | $0.00 | — | — |
| 2025 Q4 | $0.00 | $0.00 | — | — |
| 2025 Q3 | $0.00 | $0.00 | — | — |
| 2025 Q2 | $0.00 | $0.00 | — | — |
| 2025 Q1 | $0.00 | $0.00 | — | — |
Facility vs. Non-Facility (Office) Payment
Medicare often publishes two payment rates for the same code: a **non-facility** rate (typically used when the service is performed in a private office where the clinician bears more overhead) and a **facility** rate (typically used when performed in a hospital or facility where the facility bills separately for its costs).
Because the practice expense portion of RVUs differs by setting, the non-facility and facility payment amounts can be different. For locality-adjusted estimates in 2026, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
Q2 2026 Breakdown
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | 0 | 0 |
| Practice Expense (PE) | 0 | 0 |
| Malpractice (MP) | 0 | 0 |
| 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 90685?
Medicare does not cover/recognize 90685 as payable under its rules (This code is excluded/invalid for Medicare.). A national reimbursement rate is not expected for 2026.
What is the description for code 90685?
Iiv4 vacc no prsv 0.25 ml im
Why do facility and non-facility payments differ for 90685?
For many physician services, Medicare publishes different practice-expense RVUs by setting. In general, non-facility rates apply when services are performed in a private office, while facility rates apply when performed in a hospital or facility where the facility bills separately.
How can I find my local Medicare rate for 90685?
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 90685 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.