September 1st, 2017
The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Pneumococcal Vaccine and Administration:
|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 -||Administration of pneumococcal vaccine|
Who Is Covered
All Medicare beneficiaries
- 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
- 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.