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Pneumococcal Vaccination Coverage for Medicare Recipients Modified to Align with ACIP Recommendations

Posted on 01/25/15

Following a recent Advisory Committee for Immunization Practices (ACIP) recommendation, the Centers for Medicare & Medicaid Services has announced a modification to the pneumococcal vaccination coverage for patients covered by Medicare.

Under the new plan, Medicare will cover:

  • An initial pneumococcal vaccine for all Medicare Beneficiaries who are receiving the vaccine for the first time under Medicare Part B; and,
  • A second pneumococcal vaccine administered 11 full months following the previous vaccine. The vaccine must be a different sequence than the first vaccine administered.

The effective date of coverage is retroactive to September 19, 2014 dates of service, but Medicare Administrative Contractors have until February 2, 2015 to implement modifications, so be sure that your state’s contract has implemented the change prior to filing the claim.

For coding purposes, the following pneumococcal codes are available:

  • 90669 for the 7-valent vaccine
  • 90670 for the 13-valent vaccine
  • 90732 for the 23-valent vaccine

Administration of the vaccine will continue to be billed as G0009

Updated ACIP recommendations are specific to the type and sequence of the vaccination; therefore, a patient’s prior vaccination records should be reviewed. Keep in mind that a physician’s order is not required to get or administer the vaccine, so it’s important to know your patient’s history, as they may have requested it previously with another doctor or pharmacy.

If you have additional questions, please contact your KB Healthcare Consulting Senior Medical Consultant, Johna Kennedy-Preston, CPC, at (941) 953-7451 ext. 1423 or .

About the Author

Johna Kennedy-Preston

Kerkering, Barberio & Co.
1990 Main St., Suite 801
Sarasota, FL 34236
(941) 365-4617

Ms Kennedy-Preston provides clients with expertise in revenue cycle management, coding education, managed care contracting, mergers and start-up ventures, Medicare recoupment and reporting issues, credentialing with insurance carriers and assistance with state and federal licensing. Guidance is also supplied for operational improvement, policy development, procedure design and implementation, including electronic health record set up and workflows, compliance with third-party due diligence and regulatory requirements, as well as training of healthcare professionals in critical topics, both fundamental and emerging.

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