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Has anyone billed new Prevnar 13?

  1. Default Has anyone billed new Prevnar 13?
    Medical Coding Books
    The doctors in my practice told me that they want to order the new Prevnar 13 (cpt code 90670) since it recently got FDA approval but they want to know how much, on average, private insurance companies are paying for this vaccine before we order it.

    I have placed several calls with the insurance companies that we are contracted with, but have not heard back yet.

    Has anyone billed the new Prevnar and received reimbursement yet? If so it would be a huge help to know who paid what.

    Thank you.

  2. #2
    I have not even heard of that vaccine yet, What is it?.... But what I do is go online to BC/BS and check their fee schedule...hope that helps
    Kelly, CPC, CPEDC

  3. #3
    Default Pcv 13
    We have begun administering the pcv 13 but we received this from the state so we cannot charge for it, only the admin fee. This is the new pneumococcal vaccine replacing pcv 7.

  4. Default
    Our office has found out that Aetna, Cigna, Coventry, Humana and United Healthcare will be reimbursing for the PVC-13. Some have already given us a fee schedule for it. Hope this helps.

    Avg reimbursement is $130.00


  5. Default
    When billing for the prevnar 13, what ICD-9 code are you using? We billed with V03.82 and BCBS is denying the claims stating that this is not the correct dx.

    Thanks for any help

    Denise Smith CPC-A, CEMC

  6. #6
    Default Prevnar 13 DX
    V03.82 - Need for prophylactic vaccination and inoculation against bacterial diseases; other specified vaccinations against specific bacterial infections; streptococcocus pneumoniae (pneumococcocus).

    It sure looks like the best diagnosis, I wonder what BC is thinking.....maybe

    V20.2 - Routine infant or child health check; development testing of infant or child immunizations appropriate for age.

    Lori Sanders, CPC

  7. #7
    we use V20.2 and have heard Lifewise is the only insurance company not paying...not sure how true that is.
    Tina O'Sullivan CPC

  8. #8
    I am not finding this out on the ins. companies websites that you have mentioned. Do you have a link?

    Thanks so much.

  9. #9
    Default Prevnar-13
    After contacting BC/BS (yesterday) I was told that each plan benefit dictates coverage. Based on benefits the vaccine will only be covered for preventative reasons. However, upon clarification during the conversation I was quickly diverted to medical necessity. So, I am thinking contact your pharmaceutical rep and let them get the information from the insurance carriers. Being that this is a new vaccine it might be safe to say that the insurance companies are behind the 8 ball.
    Last edited by luvsgoofey; 11-27-2012 at 07:10 PM. Reason: Add credentials...Delina Thomas-Nieforth, CPC, CPC-I
    Delina Thomas-Nieforth, CPC, CPC-I

  10. #10
    Ft. Worth, Texas
    American Academy of Pediatrics vaccine coding table list 90670 (Prevnar 13)with ICD-9 V03.82.


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