All Rights Reserved. The AMA assumes no liability for the data contained herein. 2000 Prevnar is covered for children from birth to five years of age who are at high risk or presumed high risk of invasive pneumococcal infection. When Prevnar is given to treat a high risk medical condition, the primary diagnosis should be filed as the condition that places the child at high risk. The number of doses depends on the age and prior immunization status.
Coverage applies up to a maximum of four doses.
If the patient encounter is for the sole purpose of obtaining the Prevnar vaccine, an office visit should not be submitted for payment. If the vaccine is administered in conjunction with a regularly scheduled well child visit, the well child visit should be submitted for payment. Some groups have already elected coverage for Prevnar as a routine childhood immunization. All rights reserved.