PDF Version
TO: Providers Authorized for Vaccine Administration (Non-Pharmacy Providers)
RE: New Coverage for Administration of Pneumococcal Vaccine 90671 and
90677
Effective for
dates of service on or after May 1, 2022, Medicaid covers the following procedure
codes for the administration of the pneumococcal vaccine for Medicaid recipients
19 years of age or older.
Procedure
Code
|
Procedure Code Descriptor
|
Diagnosis Restriction
|
No Restriction
|
90671
|
PNEUMOCOCCAL CONJUGATE VACCINE,
15 VALENT (PCV15), FOR INTRAMUSCULAR USE
|
19y – 64y
|
65y - older
|
90677
|
PNEUMOCOCCAL CONJUGATE VACCINE,
20 VALENT (PCV20), FOR INTRAMUSCULAR USE
|
19y – 64y
|
65y - older
|
While there are
no restrictions for those 65 years and older, diagnosis restrictions have been
created to limit the pneumococcal vaccine for adults 19 to 64 years old to
those with certain chronic medical conditions or other risk factors. The
following chart lists those certain chronic medical conditions according to the
CDC website:
Alcoholism
|
Cigarette smoking
|
Phagocytic disorder, excluding
chronic granulomatous disease
|
Leukemia
|
Cerebrospinal fluid leak
|
Cochlear implant
|
Diabetes mellitus
|
Lymphoma
|
Chronic heart disease, including congestive heart failure and cardiomyopathies
|
Congenital or acquired asplenia
|
Generalized malignancy
|
Multiple myeloma
|
Chronic liver disease
|
Congenital or acquired immunodeficiency
|
HIV infection
|
Nephrotic syndrome
|
Chronic lung disease, including chronic obstructive pulmonary disease,
emphysema, and asthma
|
B- (humoral) or T-lymphocyte deficiency
|
Hodgkin’s disease
|
Sickle cell disease or other hemoglobinopathies
|
Chronic renal failure
|
Complement deficiency, particularly C1, C2, C3, or C4 deficiency
|
Iatrogenic immunosuppression, including long-term systemic corticosteroids
and radiation therapy
|
Solid organ transplant
|
Providers must
follow state and federal laws and regulations regarding administration of the
vaccine.
Providers with
billing questions should contact the Gainwell Technologies Provider Assistance
Center at
1-800-688-7989.
The Current Procedural Terminology (CPT) and Current Dental Terminology
(CDT) codes descriptors, and other data are copyright © 2022
American Medical Association and © 2022 American Dental Association (or such other date publication of CPT
and CDT). All rights reserved. Applicable FARS/DFARS apply.