Pneumococcal Vaccine and Administration

HCPCS/CPT Codes

• 90670 – Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use
• 90732 – Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use
• G0009 – Pneumococcal Administration

ICD-10 Codes

The specified below ICD codes are covered for CPT G0102 and G0103 but may not be limited and some private payers having specific guidelines.

• Z23  Encounter for immunization
• Z71.84 Encounter for health counseling related to travel

Who Is Covered

• All Medicare beneficiaries

Fee Value and MUE Edits

      CPT         Dosage   Fee    MUE
      90670 0.5 ml $241.383      1
      90732 0.5 ml $125.918     1

Frequency

• An initial pneumococcal vaccine to Medicare beneficiaries who never received the vaccine under Medicare Part B
• A different, second pneumococcal vaccine 1 year after the first vaccine was administered

Medicare Beneficiary Pays

• Co-payment/coinsurance waived
• Deductible waived