Preventive Services: Pneumococcal Vaccine and Administration

The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Pneumococcal Vaccine and Administration: 

HCPCS/CPT Codes

ICD-10 Codes

Z23

Who Is Covered

All Medicare beneficiaries

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

• Copayment/coinsurance waived
• Deductible waived

Other Notes

• Effective for dates of service on or after October 1, 2016, Medicare hospice providers may bill for vaccine services on institutional claims.
• Refer to Medicare Part B Immunization Billing and Modifications to Medicare Part B Coverage of Pneumococcal Vaccinations for more information.

Please note: The information in this educational product applies only to the Medicare Fee-For-Service Program (also known as Original Medicare). For additional guidance on using diagnosis codes, go to the Medicare Claims Processing Manual, Chapter 18 on the Centers for Medicare & Medicaid Services (CMS) website.

Watch the CMS Provider Minute: Preventive Services video for pointers to help you submit sufficient documentation when billing for certain preventive services.

• CMS: Preventive Services Chart | Medicare Learning Network

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