What's new

Protect Patients with Pneumonia Vaccines

The pneumonia vaccine is most important for young children, people with chronic conditions and older adults.

The CDC now recommends two pneumococcal vaccines for adults 65 years or older: pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23).

  • PCV13 is recommended for:
    • All children younger than 5 years old
    • All adults 65 years or older
    • Individuals 6 years or older with certain long-term health problems or a weakened immune system, including people with sickle cell disease, congenital or acquired asplenia, cerebrospinal fluid leaks and cochlear implants
  • PPSV23 is recommended for:
    • All adults 65 years or older
    • People 2 through 64 years old with certain long-term health problems or a weakened immune system, including:
      • Chronic diseases (cardiovascular, pulmonary, diabetes, alcoholism, liver disease, etc.)
      • Cerebrospinal fluid leaks or cochlear implants
      • Functional or anatomic asplenia, including sickle cell disease and congenital or acquired asplenia
      • Immunocompromising conditions, such as HIV infection, leukemia, lymphoma, Hodgkin's disease, kidney failure or organ transplant
      • Individuals currently taking a drug or treatment that lowers the body's resistance to infection, such as long-term steroids, certain cancer drugs or radiation therapy
      • Adults 19 through 64 years of age who smoke cigarettes or have asthma

Flu and pneumonia vaccinations are key to patient health and thus have become important quality metrics for programs such as the Healthcare Effectiveness Data and Information Set (HEDIS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS). Learn more about flu vaccination.

Vaccine coverage and codes:

In order to help ensure correct billing and payment, two codes are needed for each vaccination claim: one administrative code and one vaccine code. One code should be selected from each of the following groups:

Administrative codes for pneumonia vaccination include:

  • 90471, 90472, 90473, 90474
  • Medicare: G0009

Vaccine codes for pneumonia vaccination include:

  • PCV13: 90670
  • PPSV23: 90732

Questions about Humana's policies for pneumonia vaccination coverage may be directed to the member/health care provider service phone number on the back of the member's Humana ID card.