Primary Care Coding Alert

Reviewed on May 22, 2015   Question: Medicare and private payers are denying Prevnar 13 (90670, Pneumococcal conjugate vaccine, 13 valent, for intramuscular use). What should we do? Answer: Pneumococcal vaccines fall under three vaccine product codes. Choose the correct code based on the product and patient's age (older or younger than 2 years of age). For Prevnar 13 or PCV13 (pneumococcal Conjugate, 13 valent), use 90670 (Pneumococcal conjugate vaccine, 13 valent, for intramuscular use). The recommended vaccine schedule for Prevnar is that a patient receives the vaccine at ages 2 months, 4 months, 6 months, and 12-15 months. The pneumococcal vaccines Pneumovax 23 and Pnu-Immune 23 both fall under 90732 (Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use). These products are for patients 2 years of age to 65 plus years of age. Pneumovax (PPVSV) [...]