Wiki Prevnar-13 Medicare reimbursement rate

[jliving77]

I am having the hardest time finding the Medicare allowed amount for the Prevnar-13 vaccine. CPT code 90670. We are an FQHC in Az and for Medicare specifically we only get our PPS rate, but I need to know what amount, even approximately, the Advantage and Dual plans pay. The only thing I can find is the AWP pricing.
HCPCS Code.......Short Description......Dosage......Payment Limit.....Vaccine AWP%
90670....................Pcv13 vaccine im......0.5 ML........$205.113.............95
Does this mean that they will pay 95% of $205.11???

Thank you for any help you can give!

Jennifer Livingston CPC
St. Elizabeth's Health Center

 

[erjones147]

I work for a non-FQHC tribal clinic in Nevada, and we are getting $170 and change for our Prevnars