Pneumococcal Vaccine and Administration

Medicare covers pneumonia (pneumococcal, PPV), under Part B:

  • Both vaccine and administration costs covered by recognized providers
    • Includes nurses, pharmacists, under incident to supervision
  • No beneficiary coinsurance or unmet deductible applied
  • Assignment must be accepted on all vaccine claims and physician order not required
  • Two types of pneumococcal vaccines:
    • Conjugate PCV13 (CPT 90670), PCV15 (CPT 90671) or PCV20 (CPT 90677)
    • Polysaccharide PPSV23 (CPT 90732)
  • If sole purpose to administer vaccine, no E/M office visit allowed
  • Influenza and pneumonia vaccines administered same day, may bill both administration
  • Diagnosis code always used = Z23 (encounter for immunization)

HCPCS/CPT Codes

  • 90670 - Pneumococcal Conjugate vaccine, 13 valent (PCV13)
  • 90671 - Pneumococcal Conjugate vaccine, 15 valent (PCV15)
  • 90677 - Pneumococcal Conjugate vaccine, 20 valent (PCV20)
  • 90732 - Pneumococcal polysaccharide vaccine, 23 valent (PPSV23)
  • G0009 - Administration

Frequency

  • Initial vaccine to beneficiaries who never received vaccine under Medicare Part B
  • Different, second vaccine one year after first vaccine was administered

Diagnosis Code

Z23 - Encounter for immunization

Coverage

All Medicare beneficiaries are eligible

Payment

Copayment/coinsurance waived; Deductible waived

G0009 payment based on Locality-Adjusted Payment Rates

Noridian Medicare Portal

Yes. HCPCS codes 90670 and 90732 (Pneumococcal Vaccines) will display up to 10 previous dates of service and with the rendering NPI. These codes will only be viewable if the beneficiary has Medicare Part B coverage.

Resources

Last Updated Oct 11 , 2024