Summary & Overview
CPT 90670: Pneumococcal Conjugate Vaccine, 13-Valent, Intramuscular
CPT code 90670 denotes a 13-valent pneumococcal conjugate vaccine administered intramuscularly to prevent serious infections caused by Streptococcus pneumoniae, including pneumonia, meningitis, and bloodstream infections. As a routine immunization with broad public health importance, this code is central to preventive care delivery across ambulatory and outpatient settings and factors into vaccination coverage, quality reporting, and population health initiatives nationally. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, the clinical context for its use, and typical sites of service. The publication summarizes payer coverage considerations, common billing modifiers, and service-line implications to help billing managers and policy analysts understand reimbursement touchpoints and reporting requirements. Where available, benchmarks and policy updates relevant to vaccine administration and coding are highlighted. Clinical context explains indications for use and practical administration settings. Data not available in the input is noted where specific payer policies, ICD-10 pairings, and associated taxonomies were not provided.
Billing Code Overview
CPT code 90670 represents a pneumococcal conjugate vaccine administered intramuscularly to protect against 13 serotypes of Streptococcus pneumoniae that can cause invasive disease such as pneumonia, meningitis, and bacteremia. The service type is immunization/vaccine administration. The typical site of service is outpatient clinics, physician offices, community health centers, and other ambulatory care settings where routine vaccinations are provided.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient presents to a primary care clinic for routine adult immunizations. The patient has chronic obstructive pulmonary disease (COPD) and reports no prior receipt of pneumococcal conjugate vaccine in adulthood. After review of immunization history and informed consent, the clinician administers the pneumococcal 13-valent conjugate vaccine intramuscularly in the deltoid. The workflow includes verification of identity and allergies, documentation of vaccine manufacturer, lot number, and expiration date; administration using aseptic technique; observation for immediate adverse reaction for 15 minutes; and entry of the immunization into the electronic health record and any state immunization registry. Billing is submitted for the vaccine product using 90670 with an appropriate modifier if applicable, and the visit is coded to the primary diagnosis such as chronic lung disease or routine adult immunization as clinically appropriate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the same day | When an evaluation and management visit is provided in addition to vaccine administration |
59 |