90669 – Pneumococcal conjugate vaccine, polyvalent, for children under 5 years, for intramuscular use
90670 – Pneumococcal conjugate vaccine, 13-valent, for intramuscular use
90732 – – Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use
G0009 – Administration
Pneumococcal Vaccine 90669 Pneumococcal conjugate vaccine, polyvalent, when administered to children younger than 5 years, for intramuscular use B WAIVED 90670 Pneumococcal conjugate vaccine, 13 valent, for intramuscular use. WAIVED
90732 Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use WAIVED
G0009 Administration of pneumococcal vaccine WAIVED
Who Is Covered
All Medicare beneficiaries
• 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
Once in a lifetime/ Medicare may cover additional vaccinations based on risk
• Copayment/coinsurance waived
• Deductible waived
For more information, refer to https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications-Items/CMS1243321.html on the Centers for Medicare & Medicaid Services (CMS) website.
Pneumococcal and Seasonal Influenza Virus Vaccines received during the same visit Administration Codes: G0008: Influenza Virus G0009: Pneumococcal Diagnosis Code: V06.6
Use seasonal influenza virus and pneumococcal vaccine codes
Follow administration guidelines for seasonal influenza virus and pneumococcal vaccines
Hybrid Review Childhood Immunization and Lead Screenings
– The health plan is looking for all childhood immunizations and lead screenings to be completed on or before the child’s second birthday
• – in other words, 12-23 months (plus the number of days in that 23rd month just prior to the date of birth)
– Complete immunizations on or before the child’s second birthday:
• 4 – DTaP/DT (CPT – 90700; ICD-9-CM V20.2)
• 3 – IPV (90713; v04.0)
• 3 – Hep B (90743; 90744; V05.3)
• 3 – Hib (90647; v03.81)
• 4 – PCV (90670; v03.82)
• 1 – MMR (90707; v06.4)
• 1 – VZV (90716; 90660; v05.4)
When a beneficiary receives both the seasonal influenza virus and pneumococcal vaccines on the same visit, would a provider continue to report separate administration codes for each type of vaccine?
Yes. Although the provider would use diagnosis code V06.6 when an individual receives both vaccines, separate administration codes for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines should be reported. Medicare will pay both administration fees if a beneficiary receives both the seasonal influenza virus and the pneumococcal vaccines on the same day
Applicable Codes: 90460-90749, G0008, G0009, G0010, Q2034-Q2039
Codes 90460 and 90461 must be reported in addition to the vaccine and toxoid codes 90476-90749.
Report codes 90460-90461 only when the physician or qualified health care professional provides faceto-face counseling of the patient and family during the administration of a vaccine. For immunization administration of any vaccine that is not accompanied by face-to-face physician or qualified health care professional counseling to the patient/family for administration of vaccines to patients over 18 years of age, report codes 90471-90474.
Codes 90476-90748 identify the vaccine product only. To report the administration of a vaccine/toxoid, the vaccine product code must be used in addition to the administration code 90460-90474. Modifier 51 should not be reported for the vaccines/toxoids when performed with these administration procedures.
Each immunization given must be filed on a single line of the CMS 1500 claim form, with its specific CPT code.
The -25 modifier must be used with all evaluation and management services except preventive services CPT 99381-99397, when reporting a significant, separately identifiable service in addition to the immunization services.
It is inappropriate to use the unlisted vaccine code CPT 90749 to report immunization administration services.
The invoice from the laboratory or pharmacy the vaccine has been purchased from may be requested for claim review.
ZOSTAVAX® (Zoster Vaccine Live), has FDA approval for use in prevention of herpes zoster (shingles) in individuals 50 years of age and older.
CMS has data indicating the resource costs of vaccine administrations, yet continues to link payments to CPT 90782 (Therapeutic, prophylactic, or diagnostic injection). It is inappropriate for the agency to continue to link vaccine administration payments to 90782 when CPT maintains a code that describes administration of an immunization and when CMS has data on the resource costs associated with the service. ACP-ASIM has repeatedly asked CMS staff for an explanation for the linkage of Health Care Financing Administration Common Procedure Coding System (HCPCS) codes G0008, G0009, and G0010 to CPT 90782, but has not received a clear answer for this payment rationale.
ACP-ASIM also strongly believes that CMS should revise the current coding requirements for vaccine administrations by replacing the HCPCS codes G0008, G0009, and G0010. Currently, each of these G codes for vaccine administration is linked to CPT code 90782, and reimbursed by Medicare Carriers at that rate. We believe that CPT codes 90471 and 90472 should replace HCPCS codes G0008, G0009, and G0010 because these codes were created to describe an immunization administration. Using CPT codes 90471 and 90472 to record vaccine administrations will also simplify the coding requirements placed on providers. The majority of private insurance plans require providers to bill for these services by using the codes 90471 and 90472. Medicare’s requirement to use G codes for vaccine administrations is an unnecessary administrative hassle to providers that should be revised.