Expanded coverage for Capvaxive, a pneumococcal 21-valent conjugate vaccine for Commercial Members (Effective 06/17/2026)

Before June 17, 2026: Billing team must update vaccine inventory and billing systems to recognize Capvaxive as a covered vaccine for commercial members. Obtain the specific HCPCS code for Capvaxive product (likely J-code format) and corresponding CPT vaccine administration code from the payer or product documentation. Update encounter forms and billing software to allow claims submission for this vaccine. Train front desk and clinical staff to verify commercial member eligibility for Capvaxive coverage. Confirm with the insurance carrier whether prior authorization is required before administering the vaccine. Failure to use correct codes may result in claim denials or payment delays.