CPT Code 90732 | (PPSV23) Pneumococcal Polysaccharide Vaccine 23-Valent
CPT 90732 covers the administration of the 23-valent pneumococcal polysaccharide vaccine to adults or immunocompromised patients who are at least two years old, with separate codes for vaccine administration, the actual vaccine, and office visits reported based on documentation and possible use of modifier 25 for insurance purposes, following the guidelines of individual payers such as Medicare.
The CPT book defines CPT 90732 as: “Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use.”
The healthcare provider carefully informs the patient, their parent, or legal guardian about the available options for immunization with a 23-valent pneumococcal polysaccharide vaccine, which is suitable for adults or patients who are two years of age or older and immunocompromised.
The provider takes the time to comprehensively review the potential risks, benefits, and side effects associated with the vaccine.
Once the patient has been fully prepared, the healthcare provider administers the vaccine either intramuscularly or subcutaneously, depending on the specific needs and circumstances of the patient.
The provider ensures that the patient is comfortable and informed throughout the process, and is available to answer any questions or concerns that may arise.
The vaccine is an important tool in preventing pneumococcal infections and can cause a range of serious and potentially life-threatening illnesses, including pneumonia, meningitis, and sepsis.
By taking the time to carefully educate the patient and provide the vaccine, the healthcare provider is helping to protect their health and well-being.
For the administration of the 23-valent pneumococcal polysaccharide vaccine (PPV) in adults and children who are at least two years of age, the Current Procedural Terminology (CPT) code 90732 should be reported.
If a 13-valent pneumococcal conjugate vaccine (PCV) is used instead, the code to report is 90670.
When coding for immunizations, separate codes should be reported for the vaccine administration, the actual vaccine, and the office visit, based on the documentation provided by the healthcare provider.
This documentation should include sufficient information on the product administered, the administration route, and the purpose of the immunization.
In some cases, insurance companies may require the use of modifier 25 to be appended to the evaluation and management (E/M) code associated with the vaccine administration.
It is important to check with individual payers, including Medicare and private insurance companies, for their specific guidelines on reporting vaccines and to have their policies in writing.
This will help protect your practice in the event of any questions or challenges from the payer regarding the use of modifiers and may not be consistent with CPT guidelines.