Pneumonia vaccinations

Pneumonia vaccines protect your patients, especially young children, people with chronic conditions and older adults.

A doctor provides a pneumonia vaccine to a patient’s arm.

Flu and pneumonia vaccinations 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).

Recommended pneumonia vaccines

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

The 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

The PPSV23 is recommended for:

  • All adults 65 years or older
  • People 2 through 64 years of age with certain long-term health problems or a weakened immune system, including chronic diseases (cardiovascular disease, pulmonary disease, 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

Vaccine coverage and codes

In order to help ensure correct billing and payment, 2 codes are needed for each vaccination claim: 1 administrative code and 1 vaccine code. 1 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