I am having the hardest time finding the Medicare allowed amount for the Prevnar-13 vaccine. CPT code 90670. We are an FQHC in Az and for Medicare specifically we only get our PPS rate, but I need to know what amount, even approximately, the Advantage and Dual plans pay. The only thing I can find is the AWP pricing.
HCPCS Code…….Short Description……Dosage……Payment Limit…..Vaccine AWP%
90670………………..Pcv13 vaccine im……0.5 ML……..$ 205.113………….95
Does this mean that they will pay 95% of $ 205.11???

Thank you for any help you can give!

Jennifer Livingston CPC
St. Elizabeth’s Health Center