2025 HCPCS code G0009

Administration of pneumococcal vaccine.

Refer to the HCPCS coding guidelines and payer-specific instructions.

Modifiers may apply depending on circumstances; refer to payer guidelines for specific scenarios (e.g., modifier 59 for distinct procedural service if given on same day as other services).

The medical necessity for pneumococcal vaccination is established based on age, medical conditions (e.g., immunocompromised status), and CDC recommendations. Documentation should support the rationale for administration.

The physician or qualified healthcare professional is responsible for patient education on the vaccine, proper administration technique, and monitoring for adverse reactions.Post-vaccine instructions should be provided.

IMPORTANT For commercial payers, other codes like 90471 (Immunization administration) might be necessary, depending on the specific vaccine administered (e.g., PCV13, PPSV23).Always check payer-specific guidelines.

In simple words: This code is used when a doctor or nurse gives a pneumococcal shot.This shot protects against serious infections like pneumonia and meningitis.

This HCPCS code reports the administration of a pneumococcal vaccine via subcutaneous or intramuscular injection.The procedure includes patient counseling, instructions, and precautions before administering the vaccine. The pneumococcal vaccine protects against pneumococcal infection, caused by bacteria that can lead to pneumonia, septicemia, and meningitis.

Example 1: A 65-year-old patient receives a 23-valent pneumococcal polysaccharide vaccine (PPSV23) administered intramuscularly.G0009 is reported., A 5-year-old patient receives a 13-valent pneumococcal conjugate vaccine (PCV13) administered intramuscularly. G0009 is reported, along with the appropriate vaccine code (e.g., 90732 for PPSV23 or another relevant vaccine code)., A patient receives both influenza and pneumococcal vaccines on the same day.G0008 (influenza vaccine administration) and G0009 are both reported separately.

* Patient demographics.* Date of service.* Type of pneumococcal vaccine administered (e.g., PCV13, PPSV23).* Route of administration (intramuscular or subcutaneous).* Documentation of patient counseling and education regarding the vaccine.* Documentation of any adverse reactions.* Diagnosis code (Z23 for encounter for immunization).

** Always confirm the appropriate vaccine code with the payer, as codes vary depending on the specific vaccine type and the payer's guidelines.

  • RVU: Payment varies by payer and geographic location.Medicare rates are subject to change.Consult the CMS website or your payer for the most current information.
  • Global Days : Not applicable.
  • Payment Status: Active
  • Modifier TC rule: Not applicable.
  • Fee Schedule : Payment rates vary historically and geographically. Consult CMS or payer websites for historical payment data.
  • Specialties:Family Medicine, Internal Medicine, Pediatrics, Geriatrics, Infectious Disease
  • Place of Service:Office, Clinic, Hospital, Other
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