The Centers for Medicare & Medicaid Services (CMS) will now pay for administering two distinct pneumococcal vaccinations to Medicare patients. The two vaccinations must be different versions and the second vaccination must be administered at least eleven full months after the first pneumococcal vaccination.
Previously, CMS covered only one pneumococcal vaccination for the lifetime of the patients, unless the patient was considered high-risk or was unaware of their health history. The policy change is retroactive to September 19, 2014 and Medicare administrative contractors had until February 2, 2015 to implement it.
The CPT codes that should be used to distinguish and bill for the vaccinations are:
- 90669 – for the seven-valent pneumococcal vaccine;
- 90670 – for the 13-valent vaccine; and
- 90732 – for the 23-valent vaccine.
G0009 can continue to be used for the administration of the vaccine. No bundling exists with the influenza vaccine or any E/M services.