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Coding for Pneumococcal Vaccines

There are two primary Current Procedural Terminology (CPT®) codes for pneumococcal vaccines:

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

Blue Cross and Blue Shield of Alabama benefits are designed to allow one of each pneumococcal vaccine type in a lifetime for our members. In order for the provider to receive payment for the second vaccine, the second vaccine must be a different pneumococcal vaccine from the first vaccine and must be administered at least a year after the first.

For example, a patient receives a vaccine from his primary care physician. A few years later, that patient receives a second vaccine from an urgent care physician. When the urgent care physician files a claim for a pneumococcal vaccine, the claim is rejected. The denied claim may be due to incorrect coding, or the billing provider administered the same pneumococcal vaccine as the first vaccine. Either instance would cause the claim to be rejected. The member is allowed only one of each of the procedure code mentioned above.

CPT codes, descriptions and other data only are copyrighted © 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.