90732 cpt code, cpt 90732, cpt code 90732, cpt code for Pneumovax 23 , Pneumovax 23 cpt code

90732 CPT Code For Pneumovax 23 | Description, Billing & Reimbursement

The CPT code for Pneumovax 23 is described in CPT’s manual with CPT 90732. This code can be reported for pneumococcal polysaccharide vaccine, 23-valent (PPSV23). Below are the description and billing guidelines of the 90732 CPT code for Pneumovax 23.

What Is CPT 90732?

The CPT code 90732 for Pneumovax 23 can be reported for the 23-valent pneumococcal polysaccharide vaccine for adults as immunosuppressed patient dosage.

Pneumovax 23 CPT code 90732 can be reported for subcutaneous or intramuscular administration to patients two years of age or older. Report the CPT 90732 with the appropriate administration code.

Pneumococcal-polysaccharide-vaccine (CPT code 90732) can prevent pneumococcal disease.

Pneumococcal Disease Explained

Pneumococcal disease refers to any condition caused by pneumococcal bacteria. Pneumococcal bacteria are significantly known as the common cause of pneumonia. These bacterial strains may involve various infections, such as an infection of the lungs and pneumonia.

The following are the other infections caused by pneumococcal bacteria:

  • Meningitis (Inflammation of the tissue covering the brain and spinal cord)
  • Bacteremia (bloodstream infection)
  • Sinus infections
  • Ear infections

Patients of any age can get pneumococcal disease, but adults 65 years or older, children under the age of two, and cigarette smokers have a high possibility.  

Most pneumococcal infections do not have an impact on the patient’s health. In contrast, some diseases, such as Meningitis, bacteremia, and pneumonia, may be fatal. 

90732 CPT Code Description

CPT code 90732 can be reported for the service when the physician administers subcutaneous or intramuscular Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosages to individuals two years or older.

The 90732 CPT code for Pneumovax 23 is described in CPT’s manual as: “Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, administered to individuals two years or older, for subcutaneous or intramuscular use.”

How To Bil CPT Code 90732

Documentation must establish the medical necessity of the service and the appropriateness of CPT code 90732.

If an evaluation and management service (CPT 99201CPT 99499) is performed in addition to the CPT code for Pneumovax 23, it is appropriate to report separately with modifier 25 if applicable. 

If a combination of vaccines uses to administer to the patient, it is appropriate to report each component separately. 

If immune globulins and administration (CPT 90281 – CPT 90399, CPT 96365CPT 96375) perform in combination with CPT code 90732, it is appropriate to report CPT code CPT 90281 – CPT 90399, CPT 96365 – CPT 96375 separate without any modifier according to NCCI. 

CPT code 90732 includes the vaccine product Pneumovax 23. An administration code must report separately. It consists of the patient’s age for reporting purposes, not for product license. 

Documentation For The CPT Code For Pneumovax 23

The following are the documentation requirement when CPT 90732 is billed.

Documentation should indicate the Pneumovax 23 vaccine, route of administration, dosage, and any adverse reactions experienced by the patient, if applicable. 

The physician must document the patient time spent in the office after administering the Pneumovax 23 vaccine. 

Suppose the patient is uncertain about their vaccination history. In that case, CMS advises that the healthcare professional administers the Pneumovax 23 vaccine (CPT code 90732) but that the patient may be liable for the costs of the revaccination.

CPT code 90732 must bill with appropriate administration codes. It is only applicable when the clinician renders face-to-face counseling to the patient and family when the immunization administers to the patient.

Does CPT Code 90732 Need A Modifier?

Modifier 59 is can be used with CPT 90732 when the Pneumovax 23 vaccine is administered by the physician and bundled with another procedure on the same date. 

Modifier 22 can be applied to CPT 90732 when Pneumovax 23 vaccine service is performed longer than usual and extra resources are needed. For example, the physician may spend extra time counseling the patient about Pneumococcal disease.

Modifier 52 applies when the physician does not complete the immunization service and terminates due to unavoidable circumstances. 

90732 CPT Code Reimbursement

A maximum of one unit can be a bill on the same service date of CPT 90732. In contrast, the two units allow when documentation supports the medical necessity of the service.  

The cost and dosage of CPT 90732 are $133.472 and 0.5ML when performed in the facility and the non-facility. It is effective from July 1, 2022, through September 30, 2022. The refund may vary from state to state and insurance policies. 

Does Medicare Cover CPT Code 90732?

Medicare covers CPT 90732 as an initial pneumococcal vaccine for patients who have never received the vaccine and a different, second pneumococcal vaccine one year after the first vaccine.

If claim bills to the Medicare insurance, It is appropriate to report with HCPCS code G0009 for the administration. Medicare waives the Part B deductible, coinsurance, or copayment for this code when all other requirements must meet the standards.

Suppose physicians believe that medicare the CPT code for Pneumovax 23, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and CPT 90732 must be applied with the GA modifier.

The X modifiers {E, P, S, U} can be reported instead of modifier 59 with the CPT code 90732 for Pneumovax 23 vaccine to bill Medicare insurance. It divides the modifier into four parts for further specification of the procedure.

Example 1

 58 y/o male with a PMH of HTN, HLD, and hypothyroidism presents to the hospital outpatient setting because of a headache and high blood pressure before arrival.

The patient lays in bed at 10 pm and begins having a gradual onset pulsating frontal and occipital headache. He reports that the pain was very severe. His headaches are usually associated with HTN. The blood pressure shows a value of 210/100 and denies associated dizziness, chest pain, shortness of breath, motor weakness, numbness/tingling, abdominal pain, nausea/vomiting.

Patient reports improvement in HA with Tylenol. The physician ordered CT, MRI, and EKG diagnostic tests. EKG was independently interpreted and reviewed by the doctor.  

The physician discovers that the patient did not get a vaccine during the history and exam. They ask the patient to get the Pneumovax 23 vaccine.

Pneumovax 23 vaccine is administered; therefore, CPT code 90732 can be billed.

Example 2

A 51-year-old-female presents to the emergency with syncope. The patient applies a nicotine patch earlier. The patient had a brief episode of feeling hot, numbness, and tingliness in her b/l hands, “gas discomfort” in her stomach, and headache. When she tried to get up, she lost consciousness.

The patient also has flu and itching in the throat. The physician checks his vaccine status, and she needs an immediate vaccine for a covid-19 situation. 

Partner states she was only out for a few seconds before perking up to routine. Pt states she has had episodes like this in the past but several years ago.

Physicians plan to order CBC, CMP, mg, phos, trop, EKG, Tylenol, Pepcid, and Zofran. The physician also administers the Pneumovax 23 vaccine to the patient. 

Pneumovax 23 vaccine is administered to the patient; therefore, CPT 90732 can be reported.

Example 3

A 30-year-old male presents to the office with PMH HTN, HLD, Afib (on eliquis), Mitral valve replacement, and gout. He came to the office today for dark blood stools for two days.

He states that he started diarrhea yesterday and had 4 BM in the past two days. The patient denies nausea, vomiting, CP, SOB, dizziness, fevers, and chills and took eliquis this morning.

The physician also notes worsening bilateral lower extremity edema, for which he takes Lasix. He took Indomethacin for four days for a presumed gout flare. The colonoscopy was done three years ago and found a benign polyp but otherwise WNL. Physician plan to admit and Plan Labs, EKG, CT abdomen, and Pelvis, and prescribed Medicine.  

The patient did not have a vaccine in the past three years. The physician spends extra time counseling the patient and the vaccine’s benefits agreement with the doctor and gets the Pneumovax 23 vaccine.

A Pneumovax 23 vaccine is administered to the patient; therefore, the 90732 CPT code for Pneumovax 23 can be billed.

Example 4

70-year-old female presents to ED with a medical history of HLD showing the OPD for substernal chest pain.

The patient worked out daily, was a very healthy, active senior, lived at home, and worked out today. After the workout, she took a sip of water and had substernal chest pain, none radiating, associated with weakness. 

However, Gatorate helped with the substernal chest pain. She had no chest pain shortly after. However, her trainer told her to see a provider. 

She went to urgent care with asymptomatic resolved chest pain; they sent her over here because she had a family history of MI in her family. Her brother died of MI at age 48 EKG without ischemic changes. Low suspicion for ACS. HEART score 3.

The patient needs immediate vaccination because of a compromised system and a severe infection.

The physician recommends the patient get the Pneumovax 23 vaccine to avoid unintentional disease. She agrees with the physician regarding the administration of the vaccine. 

The 70-year-old female received a Pneumovax 23 vaccine; therefore, CPT 90732 is reported.

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