Prevnar 13 is a vaccine indicated for active immunization for the prevention of disease caused by streptococcus pneumonia serotypes. The average cost to the provider for this vaccine is $152.01 from Pfizer and comes in a 10 pack 1dose vial for a total cost of $1520.10. Due to the high cost we have been watching the reimbursements of this vaccine very closely. We don’t want any of our providers to be in the red with this one. As we move forward we will be providing analytical stats by insurance carrier on the actual reimbursements of the vaccine and the administration to insure that providers aren’t losing money by administering this vaccine.
If you are billing for this use CPT code 90670 for both Commercial plans and Medicare plans. Use G0009 for Medicare plan administration and 90471 for Commerical plan administration. We are using V03.82 which is pneumococcal vaccination when administered alone. Use V06.6 if patient is in your office to receive both the pneumococcal and influenza vaccinations during the same visit.
We are happy to report that reimbursements are reasonable and fair, so far we have received from $153.96 (Medicare) to $166.50 (Commercial), for the vaccine and $28.44 (Medicare) to $37.80 (Commercial), for the administration. This is just a very small sampling thus far, as the sampling gets larger the numbers will even out at a higher average. To date we have had no denials for any reason. Also note that the Medicare Part B deductible and coinsurance does not apply if patient is seeing a provider that accepts Medicare assignment.
As always, Take Advantage for all of your billing needs!