CPT Codes for Annual Wellness Visit with PCV21 and Flu Shot for 75-Year-Old Male
For a 75-year-old male receiving an annual wellness visit with a pneumococcal conjugate vaccine (PCV21) and flu shot, the appropriate CPT codes are G0438 or G0439 for the wellness visit, 90671 for PCV21, and 90662 for the high-dose influenza vaccine.
Annual Wellness Visit CPT Codes
- G0438: Annual wellness visit, includes personalized prevention plan service, first visit 1
- G0439: Annual wellness visit, includes personalized prevention plan service, subsequent visit 1
Vaccination CPT Codes
- 90671: Pneumococcal conjugate vaccine, 21-valent (PCV21), for intramuscular use 2
- 90662: Influenza virus vaccine (high-dose), for adults ≥65 years, for intramuscular use 2
Administration CPT Codes
Vaccination Recommendations for 75-Year-Old Male
Pneumococcal Vaccination
- For adults aged ≥65 years, a single dose of PCV21, PCV20, or PCV15 is recommended 2
- If PCV15 is administered, a single dose of PPSV23 should be administered ≥1 year after the PCV15 dose 2
- PCV21 contains eight pneumococcal serotypes not included in previously recommended pneumococcal vaccines but does not contain serotype 4 2
- In certain western US populations with high percentages of serotype 4 IPD, this should be considered when selecting the appropriate vaccine 2
Influenza Vaccination
- Annual influenza vaccination is recommended for all persons aged ≥6 months 2
- For adults aged ≥65 years, high-dose influenza vaccine is preferred due to increased immunogenicity in this age group 2
- Inactivated influenza vaccine (IIV) is recommended for immunocompromised patients, including those with low PCV (packed cell volume) 2
Special Considerations for Patient with Low PCV (21)
- A PCV of 21 indicates significant anemia, which may affect immune response to vaccines 2
- Patients with chronic medical conditions, including hematologic disorders, are at increased risk for pneumococcal disease 2
- Inactivated vaccines (like PCV21 and inactivated influenza vaccines) are safe for patients with hematologic disorders 2
Coding Pitfalls to Avoid
- Do not use the regular wellness visit codes (99381-99397) for Medicare patients; use the G-codes instead 1
- Document medical necessity for both vaccines, especially in a patient with anemia (PCV 21) 1
- Ensure separate administration codes (G0008, G0009) are used for each vaccine administered 2
- For patients with severe anemia (PCV 21), document this as a chronic condition that supports the need for pneumococcal vaccination 2
Concomitant Administration
- Pneumococcal and influenza vaccines can be safely administered during the same visit 3
- Studies show no clinically significant interference in immune response when PCV and influenza vaccines are administered concomitantly 3, 4
- Concomitant administration may improve vaccine uptake and compliance in older adults 4