CPT Code 90670: Pneumococcal conjugate vaccine, 13-valent, for intramuscular use

What is the 90670 CPT code?

CPT code 90670, which is under Medicare Part B, describes the administration of pneumococcal vaccine, 13-valent (PCV13), administered via intramuscular injection. This vaccine is one of two types—the other being the pneumococcal polysaccharide vaccine—that provides protection against pneumococcal disease, 13 serotypes of Streptococcus pneumoniae, a significant cause of invasive diseases such as meningitis, pneumonia, and bacteremia.

The Centers for Disease Control and Prevention established this vaccine as routinely administered to infants, young children, and individuals at increased risk, like older adults and those with underlying medical conditions, such as immunocompromised, chronic heart or lung disease, or diabetes.

It's important to note that the code falls under preventive coverage, like Medicare, for particular populations.

90670 CPT code documentation requirements

Here's a list of the requirements healthcare providers must be mindful of during the documentation process to increase the chances of proper reimbursement:

• Patient age, risk factors, and indication for pneumococcal vaccination are clearly documented.
• The administration site and route should be documented, as well as the date and time of administration.
• Vaccine name, manufacturer, lot number, expiration date, and patient education provided.
• The signature of the provider who administered the vaccine may also be beneficial for confirmation.

CPT code 90670 billing guidelines

Increase the accuracy and efficiency of coding and billing of CPT code 90670 by following the billing guidelines below:

• CPT 90670 is billed per vaccine administration.
• Administration code (90471 or 90460) should be billed separately.
• Verify vaccine coverage and patient eligibility guidelines specific to the insurer.