{"id":161708,"date":"2026-07-22T14:33:46","date_gmt":"2026-07-22T14:33:46","guid":{"rendered":"https:\/\/pabau.com\/?p=161708"},"modified":"2026-08-13T12:10:17","modified_gmt":"2026-08-13T12:10:17","slug":"cpt-code-90677","status":"publish","type":"post","link":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-90677\/","title":{"rendered":"CPT code 90677: Prevnar 20 billing, reimbursement, and modifiers"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT code 90677: Prevnar 20 billing, reimbursement, and modifiers\",\"description\":\"Complete billing reference for CPT code 90677 (Prevnar 20 \/ PCV20). Covers 2026 reimbursement rates, Medicare Part B coverage, administration codes, ICD-10 Z23, modifiers, and documentation requirements.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-90677\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-07-22\",\"dateModified\":\"2026-07-22\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key Takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key Takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT code 90677 describes the Pneumococcal Conjugate Vaccine, 20-valent (PCV20), commercially known as Prevnar 20, administered intramuscularly.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Medicare Part B covers CPT 90677 with zero patient cost-sharing (no deductible, no coinsurance) when provided by an enrolled provider.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Pair 90677 with diagnosis code Z23 and the right administration code &#8211; 90471\/90472 for commercial and Medicaid claims, but Medicare Part B requires HCPCS G0009 instead; missing either code is the most common denial trigger.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Pabau&#8217;s claims management software can auto-populate vaccine codes, administration codes, and ICD-10 diagnosis codes, reducing manual entry errors on 90677 claims.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">CPT code 90677 is the billing code for Prevnar 20, the 20-valent pneumococcal conjugate vaccine that protects adults against pneumococcal pneumonia, bacteremia, and meningitis. This guide covers the code&#8217;s official descriptor, 2026 Medicare Part B reimbursement, the administration and ICD-10 codes it pairs with, applicable modifiers, and required documentation.<\/p>\n\n\n\n<h2 id=\"h-cpt-code-90677-definition-descriptor-and-quick-reference-table\" class=\"wp-block-heading\">CPT code 90677: Definition, descriptor, and quick-reference table<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT code 90677 covers the Pneumococcal Conjugate Vaccine, 20-valent (PCV20), for intramuscular use. Maintained by the <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">American Medical Association (AMA)<\/a>, this is a Category I CPT code used by physician practices, federally qualified health centers.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The code was added to the CPT code set following FDA approval of Prevnar 20 and is the standard billing mechanism for this vaccine across Medicare, Medicaid, and most commercial payers. Below is a quick-reference table with the core billing facts.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Details<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">90677<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Official descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Pneumococcal Conjugate Vaccine, 20-valent (PCV20), intramuscular<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Brand name<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Prevnar 20 (Pfizer)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Route of administration<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Intramuscular (IM)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Category I CPT (vaccine product code)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Primary diagnosis code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Z23 (Encounter for immunization)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Administration code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">90471 (first vaccine); 90472 (each additional, same date) for commercial payers and Medicaid. Medicare Part B requires HCPCS G0009 instead; Medicare Advantage may accept either.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medicare coverage<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Part B preventive benefit, zero cost-sharing<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-prevnar-20-pcv20-the-vaccine-behind-cpt-code-90677\" class=\"wp-block-heading\">Prevnar 20 (PCV20): the vaccine behind CPT code 90677<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">PCV20 protects against 20 distinct serotypes of <em>Streptococcus pneumoniae<\/em>, the bacterium responsible for pneumococcal pneumonia, bacteremia, and meningitis. Pfizer&#8217;s Prevnar 20 extended the earlier 13-valent conjugate vaccine (PCV13, CPT 90670) by adding seven additional serotypes, broadening coverage for adults at increased risk.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The Advisory Committee on Immunization Practices (ACIP) updated its guidance in October 2024: PCV20 is now recommended as a standalone option for all PCV-naive adults 50 and older, replacing the previous age-65 threshold. Risk-based recommendations still apply for adults 19 to 64 with qualifying conditions, such as immunocompromising conditions.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Because CPT 90677 is a vaccine product code, not an administration code, it must always be billed alongside an administration code &#8211; never as a standalone line item. Providers using digital intake workflows can capture vaccination history upfront, flagging whether a patient is eligible for PCV20 versus an alternative series.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-90677\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms\"\/><figcaption class=\"wp-element-caption\"><em>Customizable consent and intake forms<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-cpt-90677-reimbursement-rates-for-2026\" class=\"wp-block-heading\">CPT 90677 reimbursement rates for 2026<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare reimburses CPT code 90677 using the Average Sales Price (ASP) plus a 6% add-on, the standard methodology for Part B vaccines. The <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS Physician Fee Schedule<\/a> updates vaccine ASP rates quarterly, so any specific dollar figure should be confirmed against the current CMS quarterly update file before billing.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CMS lists the 2026 national Medicare allowance for CPT 90677 at approximately $312.90, though the exact figure shifts with each quarterly ASP update and can vary slightly by MAC jurisdiction. Use the CMS fee schedule look-up to confirm the current allowed amount before billing.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Payer type<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Payment methodology<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Approximate 2026 rate<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medicare Part B<\/td>\n<td style=\"padding:12px 16px;color:#374151\">ASP + 6%<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Approximately $312.90 (2026); updated quarterly via CMS ASP file<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medicaid<\/td>\n<td style=\"padding:12px 16px;color:#374151\">State-specific; varies significantly<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Check your state Medicaid fee schedule<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Commercial payers<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Contract rate; geography-dependent<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Approximately $312.90 national average, based on the 2026 CMS Medicare allowance (commercial contracts vary)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Self-pay<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Practice-set charge<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Varies<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Confirm your CPT 90677 allowed amount before each quarter begins. CMS posts updated ASP files at the start of each quarter, and the vaccine rate can shift by $10 or more between updates. Set a calendar reminder to download the new file from the CMS Medicare Drug Pricing page.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">Practices running <a href=\"https:\/\/pabau.com\/features\/telehealth-software\/\">virtual consultations<\/a> can deliver education, counseling, and follow-up services remotely while billing correctly.<\/p>\n\n\n\n<h2 id=\"h-medicare-part-b-coverage-and-patient-cost-sharing\" class=\"wp-block-heading\">Medicare Part B coverage and patient cost-sharing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT code 90677 falls under Medicare Part B&#8217;s preventive vaccine benefit. That means no deductible and no coinsurance for the patient, provided the vaccine is furnished by a Medicare-enrolled provider. This is a meaningful distinction for front-desk staff: patients should not be billed a copay at the time of service.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The zero cost-sharing rule applies only when billing under the correct benefit category. Practices that also bill general preventive visits should keep vaccine line items separate so the preventive benefit applies cleanly. Good medical office billing compliance practices include training front-desk staff on this distinction during annual billing refreshers.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>No deductible:<\/strong> the Medicare Part B annual deductible does not apply to covered vaccines<\/li>\n\n\n\n<li><strong>No coinsurance:<\/strong> the standard 20% patient coinsurance does not apply<\/li>\n\n\n\n<li><strong>Provider enrollment required:<\/strong> the provider or supervising physician must be enrolled in Medicare<\/li>\n\n\n\n<li><strong>Assignment accepted:<\/strong> the provider must accept assignment for the preventive benefit to apply<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-administration-codes-to-bill-alongside-cpt-code-90677\" class=\"wp-block-heading\">Administration codes to bill alongside CPT code 90677<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The vaccine product code (90677) covers the vaccine itself. The administration of that vaccine is billed separately using CPT 90471 or 90472 for commercial payers and Medicaid. Medicare Part B requires HCPCS G0009 for the administration instead &#8211; CMS rejects 90471 on Part B pneumococcal vaccine claims, though Medicare Advantage plans may accept either code. For another example of HCPCS-coded billing.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Billing only 90677 without an administration code will result in a denied or incomplete claim in most payer systems.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">90471<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Immunization administration, first vaccine<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Commercial and Medicaid claims, when CPT 90677 is the first (or only) vaccine given that date. Not used for Medicare Part B.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">90472<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Immunization administration, each additional vaccine<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Commercial and Medicaid claims, when a second or third vaccine (e.g. influenza) is administered on the same date of service<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G0009<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Administration of pneumococcal vaccine (HCPCS)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Required on Medicare Part B claims in place of 90471; Medicare Advantage plans may accept either code<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare reimburses 90471 at approximately $30 to $35 per administration under the physician fee schedule. Administration codes are separate from the vaccine reimbursement, so both line items appear on the same claim. Practices using integrated claims management software can configure vaccine service codes to automatically attach the appropriate administration code, reducing manual pairing errors.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-90677\/automate-claims-through-healthcode.webp\" alt=\"Automate claims and billing with Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Automate claims and billing with Pabau<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Reduce claim errors on vaccine codes like 90677                <\/h3>\n\n                <p class=\"description\">\n                    Pabau&#8217;s claims management tools help practices auto-populate vaccine product codes, administration codes, and ICD-10 diagnosis codes so your 90677 claims go out clean the first time.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-icd-10-diagnosis-code-for-cpt-90677-claims\" class=\"wp-block-heading\">ICD-10 diagnosis code for CPT 90677 claims<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every claim for CPT code 90677 requires a diagnosis code. Z23 (Encounter for immunization) is the primary ICD-10-CM code used across Medicare, Medicaid, and commercial payers. Submitting 90677 without Z23 is one of the most frequently cited denial reasons in MAC billing audits. Practices coding a broad mix of encounters can see similar documentation logic in Pabau&#8217;s guide to ICD-10 code O92.3.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10 code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Use<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z23<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Encounter for immunization<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Primary diagnosis &#8211; required on all 90677 claims<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z87.39<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Personal history of other infectious and parasitic diseases<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Secondary, if clinically relevant to document elevated risk<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">D84.9<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Immunodeficiency, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Secondary, for immunocompromised patients if documented<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Secondary diagnosis codes support medical necessity documentation but do not replace Z23. Patients receiving the vaccine purely for preventive purposes should have only Z23 as the primary code. Coders managing coaching CPT codes across multiple code families benefit from building diagnosis-to-code mappings directly into their practice management system templates.<\/p>\n\n\n\n<h2 id=\"h-applicable-modifiers-for-cpt-code-90677\" class=\"wp-block-heading\">Applicable modifiers for CPT code 90677<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Modifiers provide payers with additional context about how or where a service was delivered. For CPT 90677, the modifiers below are most commonly encountered in Medicare and Medicaid billing.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When it applies<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">SL<\/td>\n<td style=\"padding:12px 16px;color:#374151\">State-supplied vaccine<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When the vaccine was supplied by a state or federal program at no cost to the practice; applicability varies by state Medicaid program<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">SA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Nurse practitioner services under supervision<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When the vaccine is administered by a nurse practitioner under physician supervision, per MAC-specific requirements<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">GY<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Item or service statutorily excluded<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Used only when billing a non-covered service for the purposes of generating a denial for secondary payer or patient billing<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The SL modifier&#8217;s applicability is not universal. Verify with your MAC&#8217;s billing articles before appending it, as state Medicaid programs and VFC (Vaccines for Children) programs have varying instructions. Practices that see a mix of IVF CPT codes can reduce modifier errors by building modifier rules directly into their billing workflow templates.<\/p>\n\n\n\n<h2 id=\"h-coverage-frequency-rules-and-immunization-schedule\" class=\"wp-block-heading\">Coverage frequency rules and immunization schedule<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare covers one dose of PCV20 per lifetime for adults 50 and older as part of the pneumococcal immunization series, per the ACIP&#8217;s October 2024 update. Risk-based recommendations still apply for adults 19 to 64 with qualifying conditions. The frequency rule depends on what the patient has previously received.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>PCV20 alone:<\/strong> one lifetime dose covers the full ACIP recommendation for adults 50+ with no prior pneumococcal vaccine history, or for adults 19-64 with a qualifying risk condition<\/li>\n\n\n\n<li><strong>PCV20 after PCV15:<\/strong> if the patient received PCV15 (CPT 90671), one dose of PPSV23 (CPT 90732) is typically recommended 12 months later, not a second PCV20<\/li>\n\n\n\n<li><strong>PCV20 after PCV13:<\/strong> CMS and ACIP guidance should be consulted; additional series doses may or may not apply depending on risk category<\/li>\n\n\n\n<li><strong>High-risk patients:<\/strong> immunocompromised patients, those with cerebrospinal fluid leaks, or cochlear implant recipients may have different sequencing requirements under ACIP guidelines<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Billing a second dose of PCV20 for a patient who already received it will result in a frequency denial. The patient&#8217;s immunization history must be documented in the chart before billing. Practices using automated clinical workflows can create pre-visit prompts that surface vaccination history from the patient record before the encounter begins, preventing this specific denial scenario.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-90677\/automated-communication-in-pabau.webp\" alt=\"Automated communication in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Automated communication in Pabau<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-documentation-requirements-for-90677-claims\" class=\"wp-block-heading\">Documentation requirements for 90677 claims<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Strong documentation protects the claim from post-payment audits and supports medical necessity for secondary diagnosis codes. The following elements are expected by most MACs.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Date of service<\/strong> and provider name or NPI<\/li>\n\n\n\n<li><strong>Vaccine name and lot number<\/strong> (Prevnar 20, manufacturer&#8217;s lot)<\/li>\n\n\n\n<li><strong>Route and site of injection<\/strong> (e.g. right deltoid, intramuscular)<\/li>\n\n\n\n<li><strong>Vaccine Information Statement (VIS) date<\/strong> and patient or guardian acknowledgment<\/li>\n\n\n\n<li><strong>ICD-10 Z23<\/strong> recorded as primary encounter reason<\/li>\n\n\n\n<li><strong>Patient&#8217;s vaccination history<\/strong> confirming frequency eligibility<\/li>\n\n\n\n<li><strong>Prescribing or supervising provider signature<\/strong> where required by MAC<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">VIS acknowledgment is a federal requirement under the National Childhood Vaccine Injury Act (NCVIA) for all vaccines on the ACIP schedule, including adult preventive vaccines like PCV20. The date the VIS was provided must appear in the patient record. Practices can use their HIPAA compliance checklist to confirm immunization records meet both billing and regulatory documentation standards.<\/p>\n\n\n\n<h2 id=\"h-common-billing-errors-and-how-to-avoid-them\" class=\"wp-block-heading\">Common billing errors and how to avoid them<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Vaccine claim denials for CPT code 90677 cluster around a predictable set of mistakes. The table below maps each error to its typical denial code and the correction action, giving billing staff a single reference to resolve and prevent the most common rejections. The same denial patterns show up on add-on procedure codes.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Billing error<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Typical denial reason<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">How to fix it<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Missing Z23 diagnosis code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CO-4 \/ PR-4: procedure inconsistent with diagnosis<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Add Z23 as primary diagnosis on every 90677 claim line<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">No administration code billed<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CO-97: benefit included in another service billed<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Always bill an administration code alongside 90677 as a separate line item &#8211; 90471\/90472 for commercial and Medicaid, G0009 for Medicare Part B<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Frequency violation (second lifetime dose)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CO-119: benefit maximum reached<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Verify immunization history before billing; appeal with clinical documentation if appropriate<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Wrong administration code (90473 used instead of 90471, or 90471 billed on Medicare Part B)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CO-4: procedure inconsistent with route or payer policy<\/td>\n<td style=\"padding:12px 16px;color:#374151\">90473 is for intranasal\/oral vaccines; PCV20 is IM &#8211; use 90471\/90472. For Medicare Part B, use G0009 instead of 90471<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">SL modifier applied incorrectly<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CO-16: claim lacks required information<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use SL only when the vaccine was state-supplied at no charge; verify with your MAC&#8217;s billing articles<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Run a monthly denial audit on all 90677 claims. Filter your remittance advice by CO-119 (frequency) and CO-4 (diagnosis mismatch). These two denial codes account for the majority of preventive vaccine rejections and both are fixable at the point of scheduling with the right pre-visit workflow checks.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-how-practice-management-software-simplifies-cpt-code-90677-billing\" class=\"wp-block-heading\">How practice management software simplifies CPT code 90677 billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most 90677 claim errors trace back to data entry rather than the clinical encounter itself. A biller manually typing the vaccine code, pairing the wrong administration code, or forgetting Z23 on a busy day creates exactly the denial patterns in the table above.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau&#8217;s claims management software addresses this by letting practices configure vaccine service templates that automatically bundle the product code, administration code, and primary diagnosis code into a single pre-built billing entry.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When a clinician records a PCV20 administration in the patient record, the linked billing template populates 90677, 90471, and Z23 simultaneously, so the biller reviews the claim rather than re-entering it. For practices running high vaccine volumes alongside other preventive codes, this cuts per-claim time and lowers the denial rate on predictable code combinations.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices exploring how practice management software handles billing workflows can apply the same template approach to other preventive care codes.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Frequency checks are another practical gain. Because Pabau&#8217;s patient records capture vaccination history alongside clinical notes, pre-visit workflows can flag when a returning patient&#8217;s chart already shows a PCV20 administration. That lets the clinical team verify eligibility before the encounter instead of catching a CO-119 denial three weeks later.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices handling CPT code 96127 alongside vaccine codes benefit from keeping both code families in one unified record instead of tracking them separately.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <a href=\"https:\/\/www.aapc.com\/codes\/cpt-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC&#8217;s CPT code lookup<\/a> remains a useful reference for verifying descriptor language and crosswalk options. But the billing workflow itself benefits most from living directly in the practice&#8217;s EHR, rather than running as a separate manual lookup step.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices that have moved vaccine billing from manual entry to template-driven submission typically see fewer pended claims and faster remittance cycles on preventive visit dates.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Related CPT codes<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-93356\/\">CPT code 93356 \u2014 Myocardial Strain Imaging<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-90715\/\">CPT code 90715 \u2014 Tdap vaccine<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-90785\/\">CPT code 90785 \u2014 Interactive complexity<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-90791\/\">CPT Code 90791 \u2014 Psychiatric diagnostic evaluation<\/a><\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Claim denials for CPT code 90677 are rarely caused by complex coverage disputes. They come down to missing Z23, the wrong administration code, or a frequency check that was skipped at scheduling. Each of those failure points is preventable at the workflow level.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau lets practices build 90677 service templates that bundle the vaccine code, administration code, and diagnosis code into a single pre-validated entry, so billers review rather than rebuild each claim. If you want to see how that fits your vaccine billing volume, <a href=\"https:\/\/pabau.com\/book-demo\/\">book a demo<\/a> with the Pabau team.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need a complete reference for other preventive CPT codes?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/coaching-cpt-codes\/\">coaching CPT codes<\/a> covers the full billing workflow for adjacent preventive care codes.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Concerned about claim documentation for HIPAA audits?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-checklist-for-primary-care\/\">HIPAA compliance checklist<\/a> outlines the documentation standards that apply to vaccine and preventive service records.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Running a multi-service primary care practice?<\/strong> <a href=\"https:\/\/pabau.com\/industry\/gp-clinic-software\/\">GP clinic software<\/a> explains how all-in-one platforms handle preventive billing, scheduling, and clinical documentation together.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently Asked Questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1784726099281\"><h3 class=\"schema-faq-question\">What is CPT code 90677?<\/h3> <p class=\"schema-faq-answer\">CPT code 90677 is the billing code for the Pneumococcal Conjugate Vaccine, 20-valent (PCV20), administered intramuscularly. It covers Pfizer&#8217;s Prevnar 20 vaccine and is used by physician practices billing Medicare, Medicaid, and commercial payers for adult pneumococcal immunization.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784726099282\"><h3 class=\"schema-faq-question\">What is the reimbursement rate for CPT 90677 under Medicare in 2026?<\/h3> <p class=\"schema-faq-answer\">Medicare reimburses CPT 90677 at the vaccine&#8217;s Average Sales Price plus a 6% add-on (ASP+6%), with rates updated quarterly. The 2026 CMS national Medicare allowance is approximately $312.90, but providers should confirm the current figure using the CMS quarterly ASP file or the CMS Physician Fee Schedule look-up tool, since the rate shifts each quarter.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784726099283\"><h3 class=\"schema-faq-question\">What administration code is used with CPT 90677?<\/h3> <p class=\"schema-faq-answer\">For commercial and Medicaid claims, CPT 90471 is used for the first vaccine administered on a given date of service, with CPT 90472 for each additional vaccine (such as influenza) given the same day. Medicare Part B requires HCPCS G0009 for the pneumococcal vaccine administration instead &#8211; CMS rejects 90471 on Part B claims &#8211; though Medicare Advantage plans may accept either code. Never bill 90677 without an accompanying administration code.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784726099284\"><h3 class=\"schema-faq-question\">What ICD-10 diagnosis code should be used with CPT 90677?<\/h3> <p class=\"schema-faq-answer\">Z23 (Encounter for immunization) is the required primary ICD-10-CM diagnosis code for all CPT 90677 claims. Secondary codes documenting elevated risk (such as immunodeficiency) may be added but do not replace Z23 as the primary code.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784726099285\"><h3 class=\"schema-faq-question\">Does Medicare Part B cover CPT code 90677 with no cost-sharing?<\/h3> <p class=\"schema-faq-answer\">Yes. Medicare Part B covers CPT 90677 as a preventive vaccine benefit with no patient deductible and no coinsurance, provided the vaccine is administered by a Medicare-enrolled provider who accepts assignment. Patients should not be billed a copay at the time of service.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784726099286\"><h3 class=\"schema-faq-question\">What is the difference between PCV20 (CPT 90677) and PCV15 (CPT 90671) for billing purposes?<\/h3> <p class=\"schema-faq-answer\">PCV15 (CPT 90671) and PCV20 (CPT 90677) are separate vaccine product codes and are never interchangeable on a claim. PCV20 covers 20 pneumococcal serotypes and typically satisfies the full ACIP adult series on its own. PCV15 requires a follow-up PPSV23 dose 12 months later. Billing the wrong code for the vaccine administered will result in a claim rejection.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784726099287\"><h3 class=\"schema-faq-question\">Is CPT 90677 the same as Prevnar 20?<\/h3> <p class=\"schema-faq-answer\">Yes. CPT 90677 is the billing code for Prevnar 20, Pfizer&#8217;s commercially available 20-valent pneumococcal conjugate vaccine. The CPT code is the billing identifier; Prevnar 20 is the brand name of the product it describes. Both refer to the same PCV20 vaccine administered intramuscularly.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>CPT code 90677 is the billing code for Prevnar 20, the 20-valent pneumococcal conjugate vaccine that protects adults against pneumococcal pneumonia, bacteremia, and meningitis. This guide covers the code&#8217;s official descriptor, 2026 Medicare Part B reimbursement, the administration and ICD-10 codes it pairs with, applicable modifiers, and required documentation. CPT code 90677: Definition, descriptor, and [&hellip;]<\/p>\n","protected":false},"author":77,"featured_media":161707,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"88","_yoast_wpseo_content_score":"60","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[3044,1236,3234,1092],"class_list":["post-161708","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes","tag-medicare-part-b","tag-medicare-reimbursement","tag-preventive-care-codes","tag-vaccine-management"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CPT code 90677: Prevnar 20 billing, reimbursement, and modifiers<\/title>\n<meta name=\"description\" content=\"CPT 90677 bills Prevnar 20 (PCV20); Medicare Part B pays about $312.90 in 2026 with zero patient cost-sharing when billed with HCPCS G0009.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-90677\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CPT code 90677: Prevnar 20 billing, reimbursement, and modifiers\" \/>\n<meta property=\"og:description\" content=\"CPT 90677 bills Prevnar 20 (PCV20); Medicare Part B pays about $312.90 in 2026 with zero patient cost-sharing when billed with HCPCS G0009.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-90677\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-07-22T14:33:46+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-13T12:10:17+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/07\/cpt-code-90677.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Katy Piper\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Katy Piper\" \/>\n\t<meta name=\"twitter:label2\" content=\"Tiempo de lectura\" \/>\n\t<meta name=\"twitter:data2\" content=\"13 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/\"},\"author\":{\"name\":\"Katy Piper\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#\\\/schema\\\/person\\\/5de22f4ff3ec59b1925ef02dce956d7d\"},\"headline\":\"CPT code 90677: Prevnar 20 billing, reimbursement, and modifiers\",\"datePublished\":\"2026-07-22T14:33:46+00:00\",\"dateModified\":\"2026-08-13T12:10:17+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/\"},\"wordCount\":2543,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/07\\\/cpt-code-90677.webp\",\"keywords\":[\"Medicare Part B\",\"Medicare reimbursement\",\"Preventive care codes\",\"vaccine management\"],\"articleSection\":[\"Billing Codes\",\"CPT Codes\"],\"inLanguage\":\"es\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/\",\"name\":\"CPT code 90677: Prevnar 20 billing, reimbursement, and modifiers\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/07\\\/cpt-code-90677.webp\",\"datePublished\":\"2026-07-22T14:33:46+00:00\",\"dateModified\":\"2026-08-13T12:10:17+00:00\",\"description\":\"CPT 90677 bills Prevnar 20 (PCV20); 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It combines scheduling, electronic health records, clinical forms, payments, marketing automation, reporting, and patient engagement tools into one secure cloud system to help practices streamline operations and grow their business.\",\"foundingDate\":\"2011-10-20\",\"numberOfEmployees\":{\"@type\":\"QuantitativeValue\",\"minValue\":\"201\",\"maxValue\":\"500\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#\\\/schema\\\/person\\\/5de22f4ff3ec59b1925ef02dce956d7d\",\"name\":\"Katy Piper\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"es\",\"@id\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/cropped-Snip20260306_177-96x96.png\",\"url\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/cropped-Snip20260306_177-96x96.png\",\"contentUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/cropped-Snip20260306_177-96x96.png\",\"caption\":\"Katy Piper\"},\"description\":\"Katy Piper is a content writer covering aesthetics, dermatology, and clinic operations, with a knack for making clinical detail feel approachable. Outside of work, she's usually chasing her border collie around muddy fields or hunting down the best flat white in town.\",\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/blog\\\/author\\\/katy-piper\\\/\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/#faq-question-1784726099281\",\"position\":1,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/#faq-question-1784726099281\",\"name\":\"What is CPT code 90677?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT code 90677 is the billing code for the Pneumococcal Conjugate Vaccine, 20-valent (PCV20), administered intramuscularly. It covers Pfizer's Prevnar 20 vaccine and is used by physician practices billing Medicare, Medicaid, and commercial payers for adult pneumococcal immunization.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/#faq-question-1784726099282\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/#faq-question-1784726099282\",\"name\":\"What is the reimbursement rate for CPT 90677 under Medicare in 2026?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Medicare reimburses CPT 90677 at the vaccine's Average Sales Price plus a 6% add-on (ASP+6%), with rates updated quarterly. The 2026 CMS national Medicare allowance is approximately $312.90, but providers should confirm the current figure using the CMS quarterly ASP file or the CMS Physician Fee Schedule look-up tool, since the rate shifts each quarter.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/#faq-question-1784726099283\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/#faq-question-1784726099283\",\"name\":\"What administration code is used with CPT 90677?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"For commercial and Medicaid claims, CPT 90471 is used for the first vaccine administered on a given date of service, with CPT 90472 for each additional vaccine (such as influenza) given the same day. Medicare Part B requires HCPCS G0009 for the pneumococcal vaccine administration instead - CMS rejects 90471 on Part B claims - though Medicare Advantage plans may accept either code. Never bill 90677 without an accompanying administration code.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/#faq-question-1784726099284\",\"position\":4,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/#faq-question-1784726099284\",\"name\":\"What ICD-10 diagnosis code should be used with CPT 90677?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Z23 (Encounter for immunization) is the required primary ICD-10-CM diagnosis code for all CPT 90677 claims. Secondary codes documenting elevated risk (such as immunodeficiency) may be added but do not replace Z23 as the primary code.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/#faq-question-1784726099285\",\"position\":5,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/#faq-question-1784726099285\",\"name\":\"Does Medicare Part B cover CPT code 90677 with no cost-sharing?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Yes. Medicare Part B covers CPT 90677 as a preventive vaccine benefit with no patient deductible and no coinsurance, provided the vaccine is administered by a Medicare-enrolled provider who accepts assignment. Patients should not be billed a copay at the time of service.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/#faq-question-1784726099286\",\"position\":6,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-90677\\\/#faq-question-1784726099286\",\"name\":\"What is the difference between PCV20 (CPT 90677) and PCV15 (CPT 90671) for billing purposes?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"PCV15 (CPT 90671) and PCV20 (CPT 90677) are separate vaccine product codes and are never interchangeable on a claim. PCV20 covers 20 pneumococcal serotypes and typically satisfies the full ACIP adult series on its own. PCV15 requires a follow-up PPSV23 dose 12 months later. 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Outside of work, she's usually chasing her border collie around muddy fields or hunting down the best flat white in town.","url":"https:\/\/pabau.com\/es\/blog\/author\/katy-piper\/"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-90677\/#faq-question-1784726099281","position":1,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-90677\/#faq-question-1784726099281","name":"What is CPT code 90677?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT code 90677 is the billing code for the Pneumococcal Conjugate Vaccine, 20-valent (PCV20), administered intramuscularly. It covers Pfizer's Prevnar 20 vaccine and is used by physician practices billing Medicare, Medicaid, and commercial payers for adult pneumococcal immunization.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-90677\/#faq-question-1784726099282","position":2,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-90677\/#faq-question-1784726099282","name":"What is the reimbursement rate for CPT 90677 under Medicare in 2026?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Medicare reimburses CPT 90677 at the vaccine's Average Sales Price plus a 6% add-on (ASP+6%), with rates updated quarterly. The 2026 CMS national Medicare allowance is approximately $312.90, but providers should confirm the current figure using the CMS quarterly ASP file or the CMS Physician Fee Schedule look-up tool, since the rate shifts each quarter.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-90677\/#faq-question-1784726099283","position":3,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-90677\/#faq-question-1784726099283","name":"What administration code is used with CPT 90677?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"For commercial and Medicaid claims, CPT 90471 is used for the first vaccine administered on a given date of service, with CPT 90472 for each additional vaccine (such as influenza) given the same day. Medicare Part B requires HCPCS G0009 for the pneumococcal vaccine administration instead - CMS rejects 90471 on Part B claims - though Medicare Advantage plans may accept either code. Never bill 90677 without an accompanying administration code.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-90677\/#faq-question-1784726099284","position":4,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-90677\/#faq-question-1784726099284","name":"What ICD-10 diagnosis code should be used with CPT 90677?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Z23 (Encounter for immunization) is the required primary ICD-10-CM diagnosis code for all CPT 90677 claims. Secondary codes documenting elevated risk (such as immunodeficiency) may be added but do not replace Z23 as the primary code.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-90677\/#faq-question-1784726099285","position":5,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-90677\/#faq-question-1784726099285","name":"Does Medicare Part B cover CPT code 90677 with no cost-sharing?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Yes. Medicare Part B covers CPT 90677 as a preventive vaccine benefit with no patient deductible and no coinsurance, provided the vaccine is administered by a Medicare-enrolled provider who accepts assignment. Patients should not be billed a copay at the time of service.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-90677\/#faq-question-1784726099286","position":6,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-90677\/#faq-question-1784726099286","name":"What is the difference between PCV20 (CPT 90677) and PCV15 (CPT 90671) for billing purposes?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"PCV15 (CPT 90671) and PCV20 (CPT 90677) are separate vaccine product codes and are never interchangeable on a claim. PCV20 covers 20 pneumococcal serotypes and typically satisfies the full ACIP adult series on its own. PCV15 requires a follow-up PPSV23 dose 12 months later. Billing the wrong code for the vaccine administered will result in a claim rejection.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-90677\/#faq-question-1784726099287","position":7,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-90677\/#faq-question-1784726099287","name":"Is CPT 90677 the same as Prevnar 20?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Yes. CPT 90677 is the billing code for Prevnar 20, Pfizer's commercially available 20-valent pneumococcal conjugate vaccine. The CPT code is the billing identifier; Prevnar 20 is the brand name of the product it describes. Both refer to the same PCV20 vaccine administered intramuscularly.","inLanguage":"es"},"inLanguage":"es"}]}},"yoast":{"focus_keyword":"CPT code 90677","seo_title":"CPT code 90677: Prevnar 20 billing, reimbursement, and modifiers","meta_description":"CPT 90677 bills Prevnar 20 (PCV20); Medicare Part B pays about $312.90 in 2026 with zero patient cost-sharing when billed with HCPCS G0009.","content_score":"60","is_cornerstone":"","related_keyphrases":[{"keyword":"pneumococcal vaccine billing","score":72},{"keyword":"CPT 90677 reimbursement","score":67},{"keyword":"CPT 90677 modifiers","score":67},{"keyword":"ICD-10 Z23 vaccine billing","score":56},{"keyword":"90471 administration code","score":61}]},"_links":{"self":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts\/161708","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/users\/77"}],"replies":[{"embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/comments?post=161708"}],"version-history":[{"count":5,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts\/161708\/revisions"}],"predecessor-version":[{"id":179396,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts\/161708\/revisions\/179396"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/media\/161707"}],"wp:attachment":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/media?parent=161708"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/categories?post=161708"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/tags?post=161708"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}