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Prevnar 13

  1. #1
    Default Prevnar 13
    Medical Coding Books
    Will Medicare pay for/cover a patient to have the prevnar 13 booster (90670)? If not, is this patient payable?

  2. Default
    Should be payable by replacing 90471 with G0009

  3. Default Prevnar 13
    We have the same question also. Will Medicare reimburse for the booster 90670 Prevnar 13 if the patient has already received the 90732?

  4. #4
    I am wondering about the coverage for Prevnar 13 also. I have been trying to find coverage information and I can't confirm if Medicare is covering this.

  5. Default
    Here is a reference:

    Medicare explicitly covers Prevnar-13. However, but we are hearing is that it will not cover Prevnar for patients who have previously received Pneumovax.

    it may take an active Congress to fix this, expected in a year or 2..

    it appears that Medicare will cover Prevnar for those who have never gotten any pneumonia vaccine.

    In my practice, we occasionally have patient's bring the e-mail that they get from Medicare showing which services they are due for. I have seen previously that Medicare notifies the patient that they are due for pneumonia vaccine 5 years after the previous pneumonia vaccine. That makes me suspect that Medicare's audits or rules will result in Medicare's covering Prevnar 5 years after a Pneumovax. I would love to know if anyone has experience with this.

    Also, it would be good to hear if anyone has gotten coverage through commercial insurance, especially Blue Cross Blue Shield.

    Thanks for your help.

  6. #6
    Quote Originally Posted by AndreaAAPC View Post
    We have the same question also. Will Medicare reimburse for the booster 90670 Prevnar 13 if the patient has already received the 90732?
    Thank you for the question AdreaAAPC, because I am on a quest to find the answer for our clinic as well.

  7. Default
    Are you billing Medicare B for Prevnar 13? I have seen conflicting information online stating that it has to be billed through Medicare D or roster billed. I am a local health department.

    Thank You!!

  8. #8
    Roanoke, Virginia
    I worked for a PCP in Virginia and I billed Medicare Part B for Prevnar 13 and was reimbursed accordingly


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