Administration of PCV13 vaccine for pneumococcal disease prevention

Description

The PCV13 vaccine is administered to infants and young children to protect against 13 strains of pneumococcus. This vaccine significantly reduces the risk of serious infections, including pneumonia and meningitis, which can have severe health implications.

Medicare Hospital Outpatient Reimbursement (OPPS)

OPPS Payment Rate

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Patient Copayment / Coinsurance

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Medicare Ambulatory Surgical Center Reimbursement (ASC)

ASC Payment Rate

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Patient Copayment / Coinsurance

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Standard copayment (20%):—

Top Modifiers

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HCPCS/CPT GAWaiver of liability statement issued per payer policy(5.42%)

HCPCS/CPT 59Distinct procedural service for non-E/M services(3.14%)

HCPCS/CPT GWService unrelated to hospice patient's terminal condition(1.88%)

HCPCS/CPT JZZero drug amount discarded or not administered(1.71%)

HCPCS/CPT GCServices performed by a resident under the supervision of a teaching physician(0.74%)

HCPCS/CPT GZItem or service expected to be denied as not reasonable and necessary(0.68%)

HCPCS/CPT GVAttending physician not employed by hospice provider(0.63%)

HCPCS/CPT CRCatastrophe or disaster-related service modifier(0.63%)

HCPCS/CPT X1Continuous patient care services without planned endpoint(0.57%)

HCPCS/CPT SLState-supplied vaccine modifier(0.51%)

Code Crosswalks

No crosswalks found.

Alternate Codes

No alternates found.

Billed With Codes

No codes found here.

Sources

We make no claims to ownership of the coding systems referenced on this platform. Codes and descriptions are produced from claims and chargemaster data available through the CMS-9915-F Transparency in Coverage Final Rule and via state or federal datasets. This service is provided solely as a reference to encourage use of these codes in our chargemaster review and automated billing tools, so that healthcare professionals can understand and correctly report these codes in their claims.

Federal and State Datasets

List of CPT/HCPCS Codes, Centers for Medicare & Medicaid Services (CMS)
I/OCE Quarterly Release Files, Centers for Medicare & Medicaid Services (CMS)
Physician Fee Schedule Relative Value Files, Centers for Medicare & Medicaid Services (CMS)
OPPS Addendum B, Centers for Medicare & Medicaid Services (CMS)
ASC Payment Addenda, Centers for Medicare & Medicaid Services (CMS)