MedicaidCoverageMedium impact
KMAP BULLLETIN: Coverage of Pneumococcal Conjugate Vaccine PCV21 (Capvaxive)
Kansas Medicaid (KanCare)·KS · Family Medicine, General Practice, Internal Medicine +2 more·Medical Policy
Effective date
Jun 27, 2024
We identified it
Jun 21, 2026
Summary
Kansas Medicaid will now cover the new pneumococcal 21-valent conjugate vaccine (PCV21) for adults 19+ with specific risk factors or age 65+. The vaccine is billed using code 90684 at $287.75 with administration code 90471 at $14.15.
Action Required
Immediately: Billing team must add CPT code 90684 ($287.75) for PCV21 vaccine to billing system for Kansas Medicaid patients. Use administration code 90471 ($14.15) or 90472 for additional vaccines. Verify patient eligibility: age 65+ or ages 19-64 with specified risk factors including immunocompromising conditions, chronic diseases, smoking, or other listed conditions. Follow CDC guidelines for proper administration coding.