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KMAP BULLETIN: Pneumococcal Vaccine Coverage Update

Date: 04/18/22

KMAP GENERAL BULLETIN 22053 (PDF)

Effective with dates of service on and after January 28, 2022, Medicaid will cover the two new pneumococcal valent vaccines, Pneumococcal 15-valent conjugate (PCV15), also known as Vaxneuvance, and Pneumococcal 20-valent conjugate (PCV20), also known as Prevnar 20, for routine vaccination in ages 65 and older, and special situations in ages 19 through 64.

Per Center for Disease Control (CDC) recommendation, Medicaid will cover routine administration of either PCV15 or PCV20 for all adults 65 years or older who have never received this vaccine or whose previous vaccination history is unknown.

Per CDC recommendation, Medicaid will cover special situation administration of the PCV15 or PCV20 for all adults 19 through 64 years of age with underlying medical conditions or other risk factors including alcoholism, chronic heart/liver/lung disease, chronic renal failure, cigarette smoking, cochlear implant, congenital or acquired asplenia, cerebrospinal fluid leak, diabetes mellitus, generalized malignancy, HIV, Hodgkin’s disease, immunodeficiency, iatrogenic immunosuppression, leukemia, lymphoma, multiple myeloma, nephrotic syndrome, solid organ transplants, sickle cell disease or other hemoglobinopathies. 

One dose of PCV15, or one dose of PCV20 will be covered with the following codes:

  • 90671
  • 90677

Note: The effective date of the policy is January 28, 2022. The implementation of State policy by the Kansas Medical Assistance Program (KMAP) will be delayed until April 4, 2022, and any denied claims will be identified and reprocessed. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.