Summary & Overview

HCPCS G8864: Pneumococcal Vaccine Administered or Previously Received

HCPCS Level II code G8864 documents that a pneumococcal vaccine was administered or that the patient previously received the vaccine. This code supports clinical documentation of immunization status and is relevant to vaccination reporting, quality measurement, and claims processing. Nationally, accurate use of G8864 matters for tracking pneumococcal vaccination coverage among adults at risk and for aligning provider records with payer and public health requirements.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical meaning and typical service settings, an outline of common modifiers used with the service, and where this code fits within vaccination billing workflows. The publication highlights benchmarks and administrative considerations for payers and providers, explains documentation expectations for immunization capture, and summarizes policy and coding updates affecting vaccine-related reporting.

This resource is intended for clinicians, billing and coding staff, and health plan administrators seeking a national-level reference on documenting pneumococcal vaccination with HCPCS Level II code G8864 and understanding its role in claims and quality measurement processes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG8864HCPCS Level IIpneumococcal vaccinevaccine administrationimmunizationambulatory carebillingquality measurement

Billing Code Overview

HCPCS Level II code G8864 indicates that a pneumococcal vaccine was administered or previously received. The service type is vaccine administration / immunization history capture, typically provided in outpatient clinic settings, primary care offices, public health clinics, and other ambulatory care sites where vaccinations or immunization records are documented.

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Clinical & Coding Specifications

Clinical Context

A 68-year-old patient presents to a primary care clinic for routine preventive care. The patient has a history of chronic obstructive pulmonary disease and hypertension and reports no prior record of pneumococcal vaccination in the electronic health record. During the visit the clinician reviews immunization history, documents informed consent, and administers a pneumococcal vaccine intramuscularly. The vaccine is recorded as either administered at this visit or previously received based on patient records or reliable patient report. Typical workflow steps include immunization screening for contraindications, verification of prior pneumococcal vaccinations, documentation of lot number and site of injection, billing with HCPCS Level II code G8864, and updating the state immunization registry where applicable. Usual sites of service are outpatient primary care clinics, community health centers, urgent care centers, and preventive care visits within ambulatory care settings.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when additional work or complexity beyond typical immunization administration is documented (rare for routine vaccine administration).
`23`	Unusual anesthesia	Not typically used for vaccination; included for completeness if an unusual anesthesia circumstance occurs.
`52`	Reduced services	Use if vaccine administration is partially reduced or an abbreviated service is provided and documented.
`53`	Discontinued procedure	Use if the vaccination encounter was begun but discontinued prior to administration for documented clinical reasons.
`54`	Surgical care only	Not generally applicable to vaccinations; included only if separate surgical billing occurs in the same encounter.
`55`	Postoperative management only	Not typically applicable to immunizations.
`62`	Two surgeons	Not applicable for vaccine administration; included for payer-specific reporting when required.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for Medicare beneficiaries	Use when a physician assistant, nurse practitioner, or clinical nurse specialist administers the vaccine for a Medicare patient under Part B reporting rules.
`CO`	Left or right modifier — Tennessee-specific (example)	Use only if specific payer or state practice requires lateral identification for injection site reporting.
`QK`	Medical direction of two, three, or four assistants	Not typically used for vaccination; included for payer compliance where assistant reporting is required.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Most common specialty providing routine adult pneumococcal vaccination in outpatient settings.
`207R00000X`	Internal Medicine	Primary physicians in adult medicine who routinely administer pneumococcal vaccines.
`363LF0000X`	Nurse Practitioner	Advanced practice providers who commonly administer vaccines in ambulatory clinics.
`363A00000X`	Physician Assistant	Mid-level providers who frequently provide immunizations in primary care and urgent care.
`261QM0800X`	Public Health Immunization Specialist	Providers in public health clinics and community vaccination programs who administer and document pneumococcal vaccines.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z23`	Encounter for immunization	Primary diagnosis code used when documenting and billing for routine preventive immunization administration, including pneumococcal vaccine.
`J44.9`	Chronic obstructive pulmonary disease, unspecified	Chronic lung disease increases risk for pneumococcal disease and is a common indication for adult pneumococcal vaccination.
`I10`	Essential (primary) hypertension	Common comorbidity found in older adults receiving routine vaccines; supports preventive care visit context.
`E11.9`	Type 2 diabetes mellitus without complications	Diabetes is an indication for pneumococcal vaccination due to increased infection risk.
`Z91.19`	Patient's noncompliance with medical treatment and regimen, unspecified	Documented when a patient has previously declined vaccination and now consents; used for historical context in immunization records.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90370`	Pneumococcal vaccine, polyvalent, for intramuscular use (e.g., PPSV23)	May be billed by suppliers or reported in inventory; relates directly to the vaccine product administered when PPSV23 is used.
`90670`	Pneumococcal conjugate vaccine, 13-valent, for intramuscular use (PCV13)	Used when PCV13 is administered; often part of adult pneumococcal immunization schedules and may appear in the clinical workflow alongside `G8864`.
`90471`	Immunization administration (per injection) (older code set; alternative administration reporting)	Represents the act of administering a vaccine; used by some payers to report administration separate from vaccine product coding.
`90472`	Immunization administration, each additional injection (used with `90471`)	Used when multiple injections are given in the same encounter; may be applicable if additional vaccines are administered with the pneumococcal vaccine.
`G0008`	Administration of influenza vaccine preventive immunization (Medicare)	Example of a preventive vaccine administration HCPCS used in similar workflows; included to show analogous billing practice though for influenza rather than pneumococcal.