CPT® Code 90677

Last Updated: January 2026 | Verified for 2026 AMA, CPT & CMS Guidelines

Quick Reference: CPT 90677

• Definition: Pneumococcal conjugate vaccine, 20-valent (PCV20), intramuscular use. CPT 90677 is the product code for Prevnar 20®, which protects against 20 serotypes of Streptococcus pneumoniae.
• Indication: Recommended for all adults 50 years and older, and adults 19–49 with qualifying risk factors (e.g., chronic heart, lung, liver disease, diabetes, smoking, immunocompromising conditions) who have not previously received a pneumococcal conjugate vaccine. Approved in 2023 for routine pediatric use as an alternative to PCV13.
• Dosage & Schedule: 0.5 mL IM per dose. In adults, administered as a single dose (no PPSV23 required afterward if PCV20 is used). In infants, administered as a 4-dose series at 2, 4, 6, and 12–15 months when PCV20 is selected for routine immunization.
• Coding Tips: Report 90677 for the vaccine product only. Bill a separate administration code (90471, 90460, or HCPCS G0009 for Medicare Part B). Append modifier 25 to any separately identifiable E/M service performed on the same date.
• Exclusion: Do not use CPT 90677 for other pneumococcal vaccines. Use 90670 (PCV13), 90671 (PCV15), or 90732 (PPSV23) only when those specific products are administered. Do not report more than one pneumococcal vaccine product code for the same patient on the same date of service.

CPT 90677 represents the 20-valent pneumococcal conjugate vaccine (PCV20), marketed as Prevnar 20®. This vaccine expands pneumococcal serotype coverage beyond earlier conjugate vaccines and is used to prevent invasive pneumococcal disease, including pneumonia, bacteremia, and meningitis. From a coding perspective, 90677 identifies only the vaccine product; the administration of the injection must always be billed separately using the appropriate CPT or HCPCS administration code.

The introduction of PCV20 significantly simplified pneumococcal vaccination strategies. Historically, adult vaccination required sequencing PCV13 followed by PPSV23. Current ACIP guidance favors higher-valency conjugate vaccines, and PCV20 now serves as a single-dose solution for many adults, eliminating the need for subsequent polysaccharide vaccination in routine cases.

As of 2023, ACIP no longer recommends routine use of PCV13 for any population. Instead, PCV20 or PCV15 are preferred conjugate options in both adults and children. This shift has direct billing implications: CPT 90677 has become the primary pneumococcal conjugate vaccine product code used in adult preventive care and is now an accepted option within the pediatric immunization schedule.

flowchart TD
    A[Patient Needs Pneumococcal Vaccine] --> B{Age Group?}
    B -->|Adult >=50| C[PCV20 single dose<br/>CPT 90677]
    B -->|Adult 19-49| D{Risk Factors?}
    D -->|Yes| C
    D -->|No| E[Not routinely indicated]
    B -->|Infant/Child| F[PCV20 4-dose series<br/>CPT 90677]
    C --> G{Payer?}
    G -->|Medicare Part B| H[Admin: G0009]
    G -->|Commercial/Medicaid| I{Patient Age?}
    I -->|>=18| J[Admin: 90471]
    I -->|<18 with counseling| K[Admin: 90460]

Indications & Eligibility Criteria

CPT 90677 is indicated for preventive immunization against pneumococcal disease using the 20-valent conjugate formulation. ACIP guidance initially focused on adults aged 65 and older and adults aged 19–64 with specific risk factors, recommending either PCV20 or PCV15. When PCV15 is used, a subsequent dose of PPSV23 is required to broaden serotype coverage.

Updated ACIP recommendations expanded routine use of PCV20 to all adults aged 50 years and older, regardless of underlying health status. This represents a significant change in preventive care practice, positioning pneumococcal vaccination alongside other age-based preventive services such as influenza vaccination.

Adults aged 19–49 remain eligible when they have qualifying risk factors and have not previously received a pneumococcal conjugate vaccine consistent with current guidance. Individuals who previously received PCV13, PPSV23, or both may still qualify for PCV20 depending on timing and vaccine history, as described in Medicare coverage updates.

For pediatric patients, ACIP and the American Academy of Pediatrics now recognize PCV20 as an option for routine pneumococcal vaccination in infants and children. PCV20 may be used in the standard infant series or for catch-up vaccination, depending on age and prior immunization history.

Dosage, Schedule & Administration

Dosage: Each dose of Prevnar 20 is 0.5 mL administered intramuscularly. The vaccine is supplied as a single-dose syringe and should not be diluted.

Adults: For most adults, PCV20 is given as a single dose. No routine booster or PPSV23 follow-up is required when PCV20 is used as the conjugate vaccine of choice.

Pediatrics: When used in infants, PCV20 follows the traditional conjugate schedule: doses at 2, 4, 6, and 12–15 months. Older children who are unvaccinated or incompletely vaccinated may receive PCV20 as part of a catch-up schedule.

Co-administration: PCV20 may be administered during the same visit as other vaccines, such as influenza or COVID-19 vaccines, using separate injection sites. Each vaccine product and administration must be reported separately.

Documentation & ICD-10 Coding

Medical record documentation must include vaccine name, manufacturer, lot number, date administered, route, site, and the individual administering the vaccine. Provision of the Vaccine Information Statement (VIS) should also be documented.

For billing purposes, link CPT 90677 to ICD-10-CM Z23 (encounter for immunization). Pneumococcal vaccination is considered a preventive service; additional diagnoses are not required for payment, though documenting relevant risk factors is recommended.

If a significant E/M service is performed on the same date, documentation must clearly distinguish the evaluation from the vaccination to support modifier 25 usage.

Medicare Coverage & Preventive Billing

Medicare Part B covers pneumococcal vaccines as preventive services with no beneficiary cost-sharing. Claims must include CPT 90677 for the vaccine product and HCPCS G0009 for pneumococcal vaccine administration.

Medicare coverage policies have been updated to align with ACIP guidance, allowing PCV20 for beneficiaries who have not previously received a conjugate vaccine and, in some cases, for those who completed older vaccination regimens.

When pneumococcal vaccination is the sole service provided, an E/M code should not be billed. Separate E/M services require appropriate documentation and, when applicable, modifier 25.

Administration Codes & Modifier Usage

Administration codes:

• 90471 – First vaccine administration (no counseling)
• 90472 – Each additional vaccine administered
• 90460 – Pediatric administration with counseling (under 18)
• G0009 – Medicare Part B pneumococcal vaccine administration

Modifier 25: Append to E/M services that are significant and separately identifiable from the vaccine administration.

Modifier SL: Required by some Medicaid programs when the vaccine is state-supplied (e.g., VFC). State-specific rules apply.

Comparison: 90670 vs 90671 vs 90677 vs 90732

Clinical Scenario Examples

Scenario 1: Medicare Preventive Vaccination

A 66-year-old Medicare beneficiary with no prior pneumococcal vaccination receives Prevnar 20. Bill CPT 90677 with HCPCS G0009 and ICD-10 Z23. No PPSV23 is required.

Scenario 2: Prior PCV13, Now PCV20

A 70-year-old patient previously vaccinated with PCV13 receives PCV20 to broaden serotype protection. Billing includes CPT 90677, administration code, and Z23.

Scenario 3: Pediatric Well-Child Visit

A 6-month-old infant receives PCV20 during a well-child visit with counseling. Bill CPT 90677 and administration code 90460. Preventive E/M services are billed separately.