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Pneumococcal Vaccine and Administration

Medicare covers flu, pneumococcal, and Hepatitis B shots. Flu, pneumococcal infections, and Hepatitis B can be life threatening to an older person. This is especially important for those who have chronic illness, including heart disease, lung disease, diabetes, or End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).

HCPCS/CPT Codes


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

ICD-10-CM (ICD-9-CM) Codes


Report one of the following codes:

  • Z23 (V03.82) – Pneumococcus
  • Z23 (V06.6) – Pneumococcus and Influenza

Who Is Covered


All Medicare beneficiaries

Frequency


  • An initial pneumococcal vaccine to Medicare beneficiaries who never received the vaccine under Medicare Part B; and
  • A different, second pneumococcal vaccine 1 year after the first vaccine was administered

Beneficiary Pays


  • Copayment/coinsurance waived
  • Deductible waived

Frequently Asked Questions (FAQs)


Will Medicare pay for the pneumococcal vaccination if a beneficiary is uncertain of his or her vaccination history?

Yes, if a beneficiary is uncertain about his or her vaccination history, provide the vaccine and Medicare will cover the revaccination.

When a beneficiary gets both the seasonal influenza virus and pneumococcal vaccines on the same visit, do I continue to report separate administration codes for each type of vaccine?

Yes, use diagnosis code V06.6 and separate administration codes for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. Medicare pays both administration fees if a beneficiary gets both the seasonal influenza virus and the pneumococcal vaccines on the same day.

Can I roster bill the seasonal influenza virus, pneumococcal, and hepatitis B vaccines?

No, you may roster bill only the seasonal influenza virus and pneumococcal vaccines. You cannot roster bill the hepatitis B vaccine.

May I submit a single roster claim containing information for both the seasonal influenza virus and pneumococcal vaccines when the vaccines are administered on the same visit?

No, you must prepare a separate roster claim for the seasonal influenza virus vaccine and the pneumococcal vaccine. However, you may file an individual claim containing information for both types of vaccines.

Other Notes


References



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