Skip to main content

Pneumococcal Vaccine Claims Processing Updates April 2022

The Pneumococcal Vaccine CPT codes will be payable by Medicare. The new codes will be in the 2021 Medicare Physician Fee Schedule Database file update and the annual HCPCS update. 

90677-  Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use.

  • Which is effective for Dates of Service (DOS) on or after July 1, 2021

90671 - Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use

  • Which is effective for DOS on or after July 16, 2021 

The CPT 90677 does not apply for Coinsurance and deductible.

A Medicare Administrative Contractor (MAC) will pay institutional providers for these codes based on the Type of Bill (TOB) used. The two payment methods are,

      1. The Medicare Administrative Contractor (MAC) will pay these institutional providers using reasonable cost if you use the following,

    • Hospitals (TOBs 12X and 13X)
    • Skilled Nursing Facilities (TOBs 22X and 23X)
    • Home Health Agencies (TOB 34X)
    • Hospital-based Renal Dialysis Facilities (RDFS) (TOB 72X)
    • Critical Access Hospitals (CAHs) (TOB 85X)
      2. A MACs will pay these institutional providers based on the lower of the actual charge or 95% of the Average Wholesale Price (AWP) if you use,
    • Comprehensive Outpatient Rehabilitation Facilities (TOB 75X)
    • Independent RDFs (TOB 72X)
    • Indian Health Services (IHS),
      • Hospitals (TOBs 12X and 13X)
      • Hospices (TOBs 81X and 82X)
      • IHS CAHs (TOB 85X)

A MAC will hold  the claims they get before April 1, 2022, for mentioned below CPT codes,

  • HCPCS code 90677 with DOS on and after July 1, 2021
  • HCPCS code 90671 with DOS on or after July 16, 2021

A MAC will process the claims when Medicare systems are ready on April 4, 2022. Also, your MAC will initiate a mass adjustment for any claims that rejected with HCPCS 90677 with a DOS from July 1, 2021 to September 30, 2021. 

They will also adjust rejected claims with HCPCS code 90671 with dates of service from July 16, 2021 to March 31, 2022. These adjustments will occur after April 4, 2022.

Popular posts from this blog

CPT Changes - New CPT Codes '2022

Glimpses of CPT Codes Updates - Effective from January 1st 2022 There are more than 400 codes are changes in 2022 from AMA. Total number codes are changed 405 and including of followings, New Codes -  249  Revised Codes - 93  Deleted Codes - 63 More than 40% of the editorial changes are tried to new technology services described in Category III CPT codes and the continued expansion of the proprietary laboratory analyses section of the CPT code set. Five new CPT codes are created for therapeutic remote monitoring codes 98975, 98976, 98977, 98980 and 98981 to increasingly important avenue of patient care especially during the COVID-19 pandemic. Five new CPT codes are created for complex care management codes 99424, 99425, 99426, 99427 and 99437 a nd there are some changes in chronic care management CPT codes as well. Six new CPT codes are created for Cardiac Catheterization codes 93593, 93594, 93595, 93596, 93597 and 93598 for congenital heart defects. Also, there are some changes in ele

Annual Preventive and Wellness Visit Service

Preventive Service Codes The annual preventive exam is a periodic, comprehensive preventive medicine evaluation (or reevaluation) and management of the patient. The CPT Code selection is based on whether the patient is receiving an initial visit -"New Patient" or a periodic - "Established Patient" preventive service, as well as the patient’s age. Initial Visits - 99381, 99382, 99383, 99384, 99385, 99386, 99387 Subsequent Visits - 99391, 99392, 99393, 99394, 99395, 99396, 99397 The Medicare insurance would be covered by "G" codes instead of the above codes. The details below, Welcome to Medicare - G0402 (Within the one year from the patient enrolled in Medicare) Initial Annual Wellness Visit - G0438 (After the 1st year of enrollment) Subsequent Annual Wellness Visit - G0439 Initial Visits Initial comprehensive preventive medicine evaluation and management of an individual including an" age and gender appropriate history, examination, counseling/anticip

CPT Changes - Deleted CPT Codes'2022

 CPT Code CPT Description 0191T Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork; initial insertion 01935 Anesthesia for percutaneous image guided procedures on the spine and spinal cord; diagnostic 01936 Anesthesia for percutaneous image guided procedures on the spine and spinal cord; therapeutic 0208U Oncology (medullary thyroid carcinoma), mRNA, gene expression analysis of 108 genes, utilizing fine needle aspirate, algorithm reported as positive or negative for medullary thyroid carcinoma 0290T Corneal incisions in the recipient cornea created using a laser, in preparation for penetrating or lamellar keratoplasty (List separately in addition to code for primary procedure) 0355T Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), colon, with interpretation and report 0356T Insertion of drug-eluting implant (including punctal dilation and implant removal when performe