Medicare AdvantageBilling CodesMedium impact
MA00.003ag, Preventive Care Services
Independence Blue Cross·Allergy & Immunology, Family Medicine, Geriatrics +1 more·Medical Policy
Effective date
Apr 1, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage policy MA00.003ah (effective 04/01/2026) adds coverage for two new preventive vaccines: mNEXSPIKE COVID-19 vaccine (CPT 91323) and PCV21 pneumococcal vaccine (CPT 90684) for adults 18+. Pneumococcal vaccine timing criteria were updated to align with CDC guidelines. Billing teams must update systems to recognize these new codes for preventive claim submission.
Action Required
By March 31, 2026: Billing team must update billing system and claims processing software to recognize CPT codes 91323 (mNEXSPIKE COVID-19 vaccine) and 90684 (PCV21 pneumococcal vaccine) as covered preventive services under Independence Blue Cross Medicare Advantage plans. Update fee schedules, prior authorization rules (if any), and encounter forms to include these codes. Coordinate with clinical staff to ensure documentation supports CDC pneumococcal vaccine timing guidelines per the revised criteria. Test claims submission before April 1, 2026 to prevent claim denials or delays. Failure to implement may result in initial claim rejections until corrected.