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Billing 90670 to Medicare

HeatherM

New
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New guidelines have come out that a Prevnar 13 should be given to any medicare patient a year after they have received the Pneumovax. Then 6 months after the Prevnar 13 is given, they should be given another Pneumovax booster. This is a recent bulletin from medicare, however there is no information on CMS as to how to bill or what the reimbursement rate is for it. If anyone has any insight to share on the proper way to do this and the appropriate reimbursement for this, an information would be greatly appreciated.
 

Asmith2284

Contributor
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reimbursement

We have been billing it as followed and getting paid for it.. I was unaware of the Booster for the Prevnar.

G0009- reimbursed 23.39
90670- reimbursed 150.88
 
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Billing Prevnar 13

We haven't billed any yet, but CMS has 90670 listed under its Immunization Billing page as "once in a lifetime" frequency of administration; to me this means that they probably won't cover any boosters.
 
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