CPT 90677: 20‑Valent Pneumococcal Conjugate Vaccine, IM
Commercial payers pay $313 on average nationally for this procedure.
CPT code 90677 describes a 20‑valent pneumococcal conjugate vaccine administered intramuscularly to protect against pneumococcal bacterial disease; the service is a vaccine administration typically provided in outpatient clinical settings such as primary care, pediatrics, family medicine, or infectious disease clinics for immunization purposes.
For related coverage guidance, see recent payer policy updates: B-Hemolytic Streptococcus Testing, Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance Assays, Hepatitis Testing (A, B, C, D) Coverage Criteria.
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National Reimbursement Benchmarks
Commercial reimbursement centers near BUCA’s average of $312.70 for CPT 90677, with most national payers clustering in the low-to-mid $300s. Blue Cross Blue Shield’s median sits near $297 and Aetna and UnitedHealth Group medians are around $312 and $310 respectively, while Cigna and BUCA both report medians near $308–$305. Maximums vary more: Aetna and Blue Cross Blue Shield show higher upper bounds, pushing peaks above $700 and $800 for Aetna and BCBS respectively, while Cigna and BUCA remain constrained in the $300s.
Dispersion analysis (P75 minus P25) highlights variation: Blue Cross Blue Shield’s interquartile spread is $45.30 ( $325.30 - $280.00 ), UnitedHealth Group’s spread is $59.90 ( $334.50 - $274.60 ), Aetna’s spread is $94.80 ( $378.50 - $283.70 ), Cigna’s spread is effectively $0.00 ( $307.60 - $307.60 ), and BUCA’s spread is $49.00 ( $334.20 - $285.20 ). This identifies Cigna as the tightest and Aetna as the widest payer distribution around BUCA’s commercial average.