Pneumococcal Vaccine and Administration - JE Part B

To learn more on billing pneumococcal, visit the Influenza and Pneumonia Billing webpage.

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

• Influenza and Pneumonia Billing
• CDC Pneumococcal Vaccine Timing for Adults
• CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 50.4.4.2
• CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 10
• CMS Medicare Learning Network (MLN) Publications
• CMS Medicare Preventive Services
• CMS Roster Billing for Mass Immunizers
• CMS Vaccine Pricing