Coverage for pneumococcal conjugate vaccine (PCV15), effective 1/1/2023

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Apple Health (Medicaid) Provider Alert

Attention providers

What changed? 

Effective for dates of service on and after January 1, 2023, to align with the Washington State Department of Health, the Health Care Authority (HCA) will begin covering the following pneumococcal vaccine (PCV15) code for all ages:

CPT®
code                Short description                               Ages              

90671              Pcv15 vaccine im                                 All ages

For ages 0 through 18, this vaccine is free from the Department of Health, under the federal Vaccines for Children (VFC) program.

Fee Schedules

HCA revised the Professional Administered Drug Fee Schedule, the Enhanced Pediatric Fee Schedule and the Outpatient Perspective Payment Systems (OPPS) Fee Schedule to reflect this vaccine code. See HCA’s Provider billing guides and fee schedules.

CPT® codes and descriptions only are copyright 2021 American Medical Association.