Cpt 90677 Reimbursement 2023 (2024)

FAQs

Does Medicare pay for CPT code 90677? ›

B. Policy: Effective for claims processed with Dates of Service (DOS) on or after October 1, 2021, pneumococcal conjugate vaccine code 90677 (Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use) will be payable by Medicare.

Effective retroactively for dates of service on or after April 27, 2023, the age limit for CPT^® code 90677 (influenza virus vaccine, pandemic formulation, split virus, adjuvanted, for intramuscular use) for Prevnar^® 20 (20-valent pneumococcal conjugate vaccine) has been updated to include children of at least six weeks ...

Do Medicare prescription drug plans cover Prevnar 20? No. In general, Medicare prescription drug plans (Part D) do not cover this drug.

PNEUMOVAX 23 CPT code: 90732.

Since this vaccine is distributed by the Texas Vaccines for Children (TVFC) Program, procedure code 90677 will process as informational-only when administered to individuals who are 2 months through 18 years of age.

The modifier “SL” indicates state-supplied vaccine. This modifier is to be applied to codes to identify administration of vaccines provided at no cost by DPH.

Procedure code 90671-Vaxneuvance™ (pneumococcal 15-valent conjugate vaccine), use expanded to individuals 6 weeks of age or older. Procedure code 90756- Flucelvax® Quadrivalent (influenza vaccine) use expanded to individuals 6 months of age or older.

Active immunization for the prevention of otitis media caused by S. pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F in individuals 6 weeks through 5 years of age.

The Centers for Medicare & Medicaid Services suggests submitting separate claims for this vaccine using CPT code 90677, “Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use.” Don't forget to also report the appropriate CPT code for administration of the vaccine.

Why is Prevnar so expensive? ›

And there are good reasons for price hikes on existing shots, too. Vaccines are more complicated--and expensive--to develop and to manufacture than ever. A Pfizer spokeswoman told the Times that vaccine plants cost $600 million to build and one batch of Prevnar 13 takes two years of work.

Medicare Part B covers two separate pneumonia vaccines. Part B covers the first shot if you have never received Part B coverage for a pneumonia shot before. You are covered for a different, second vaccination one year after receiving the first shot.

Pneumococcal vaccinations and flu shots

The CPT codes for the pneumococcal vaccine are 90669 and 90732. There are four codes for flu vaccine: 90657, 90658, 90659 and 90660.

The cost of pneumococcal vaccination depends on factors such as the type of vaccine, brand, manufacturer, applicable taxes and the vaccination service provider. Generally, the cost of one dose of pneumococcal vaccination ranges between Rs 2200 to Rs 4000.

Part D plans must include most commercially available vaccines on their formularies, including the vaccine for shingles (herpes zoster). The only exceptions are flu, pneumonia, hepatitis B, and COVID-19 vaccinations, which are covered by Part B. As of January 2023, all Medicare-covered vaccines should be free to you.

Local Coverage Articles, authored by the Medicare Administrative Contractors (MACs), include these codes and, when paired with the related Local Coverage Determination (LCD), outline what is and is not covered by Medicare. On the Medicare Coverage Database (MCD) you can use CPT/HCPCS codes to search for documents.

Your costs in Original Medicare

Part D covers all vaccines that the Advisory Committee on Immunization Practices (ACIP) recommends, including vaccines for RSV, shingles, whooping cough, and more. Your drug plan won't charge you a copayment or deductible for vaccines that ACIP recommends.

Part B (Medical Insurance)

covers the seasonal flu shot (or vaccine) once per flu season and additional flu shots if it's medically necessary.

Medicare Part B pays for several vaccines to help prevent disease. This includes the tetanus vaccination, but it does not pay for a Tdap tetanus booster. Medicare Part D, the prescription drug plan, does cover the Tdap vaccine, and it also pays for most commercially available vaccines to prevent illness.