CPT Code 90677: Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use

What is CPT code 90677?

CPT code 90677 describes the 20-valent pneumococcal conjugate vaccine (PCV20), administered via intramuscular injection. This vaccine protects against 20 different serotypes of Streptococcus pneumoniae, a leading cause of pneumonia, meningitis, and bloodstream infections. It is primarily indicated for adults and specific high-risk populations, following guidelines from the Centers for Disease Control and Prevention (CDC) and Advisory Committee on Immunization Practices (ACIP), which are updated annually to reflect the latest clinical evidence and recommendations.

PCV20 (marketed as Prevnar 20) offers broader protection than previous pneumococcal vaccines and is often administered as a single-dose immunization. Healthcare providers should consult the most updated Medicare and commercial insurance guidelines to determine patient eligibility and establish correct billing protocols.

Documentation requirements

Proper documentation ensures that CPT 90677 is reimbursed correctly and that the vaccine is medically necessary for the patient.

Patient eligibility and indication

The medical record must reflect why the vaccine was indicated, including age, immunocompromised status, chronic health conditions (e.g., diabetes, COPD), or lack of prior pneumococcal vaccination. Documentation should also show compliance with CDC immunization schedules and applicable payer criteria.

Vaccine name and administration details

Note the full name of the vaccine (e.g., PCV20 or Prevnar 20), dose, route (intramuscular), and site of administration. Include the lot number and manufacturer, as well as the date the vaccine was given.

Consent and education

Confirm that the patient or guardian received vaccine information, had the opportunity to ask questions, and provided informed consent. Documentation of this step is important for both clinical and legal compliance.

Billing guidelines

Correct billing for CPT 90677 requires attention to both the product and its administration, as well as awareness of payer-specific rules.

Report both product and administration codes

CPT 90677 is used to bill for the vaccine product itself. Be sure to report a separate administration code—typically 90471 for adults—for the intramuscular injection of the vaccine. These codes must be supported by appropriate documentation and cannot be bundled.

Medicare and payer coverage

Medicare Part B may cover 90677 for certain high-risk adults and immunization-eligible populations. Medicare Part D or commercial plans may also cover the vaccine, depending on vaccination history and current guidelines. Providers should refer to current Medicare guidance or the patient’s insurance plan for coverage eligibility and billing instructions.

Use diagnosis codes to support medical necessity

Pair 90677 with appropriate ICD-10 codes, such as Z23 (encounter for immunization) and codes indicating high-risk conditions when applicable. Claims missing a valid diagnosis may be denied.

Claims processed by different payers

Be aware that vaccine claims may be processed by medical or pharmacy benefits, depending on the insurer. Confirm the billing pathway in advance to ensure proper reimbursement and reduce claim denials.

Other related CPT codes

• 90471 – Immunization administration (one vaccine, intramuscular)
• 90732 – Pneumococcal polysaccharide vaccine (PPSV23)
• 90670 – Pneumococcal conjugate vaccine, 13-valent (PCV13)