Cpt 90677 Reimbursem*nt 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.

Your costs in Original Medicare

You pay nothing for a flu shot if your doctor or other health care provider accepts assignment for giving you the shot. If you have a Medicare Advantage Plan, contact your plan for details.

This code represents a vaccine product administered intramuscularly to protect against pneumococcal disease, a bacterial infection. This is a 20–valent vaccine, protecting against 20 strains of the bacteria.

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.

Pneumococcal 20-Valent Conjugate Vaccine, Suspension for Intramuscular Injection (Prevnar 20™) HCPCS Code 90677: Billing Guidelines.

SL (state-supplied vaccine) must be used when administering vaccine supplied by the Vaccines for Children (VFC) program. Influenza vaccine is a suspension of inactivated influenza viruses for Intradermal Injection. All ACIP-recommended indications.

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.

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.

Medicare Part B provides preventive coverage only for certain vaccines. These include: Influenza: once per flu season (codes 90630, 90653, 90656, 90662, 90673-74, 90682, 90685-88, 90756, Q2035, Q2037, Q2039) Pneumococcal: (codes 90670, 90732, once per lifetime with high-risk booster after 5 years)

Do I have to pay for vaccines with Medicare? You pay nothing for vaccines covered by Part B – flu, pneumonia and Hepatitis B – as long as your provider accepts Medicare. If you have Part D coverage, you also won't pay anything for vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP).

Fluzone is approved for use in persons 6 months of age and older. Flublok is approved for use in persons 18 years of age and older.

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.

Tdap: This vaccine protects against tetanus, diphtheria, and pertussis or whooping cough. Medicare Parts A and B do not cover the shot, but Medicare Part D will pay for the Tdap. For other shots related to tetanus, a person may wish to check their coverage with their plan provider.

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.