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The pneumococcal conjugate vaccine, 13 valent (PCV13), is a crucial immunization designed to provide active and long-term immunity against pneumococcal diseases. Vaccines function by introducing altered versions of specific pathogens, such as viruses or bacteria, into the body. This exposure prompts the immune system to produce antibodies, which are proteins that help fight off infections. Once the immune system has been exposed to the vaccine, it retains a memory of how to produce these antibodies, enabling a quicker and more effective response if the individual encounters the actual pathogen in the future. Pneumococcal bacteria, specifically Streptococcus pneumoniae, can reside harmlessly in the nose and throat; however, they pose a significant risk when they invade other parts of the body, potentially leading to severe conditions such as pneumococcal pneumonia, bacteremia, and meningitis. Certain populations, including young children, the elderly, and individuals with compromised immune systems, are particularly vulnerable to these infections. The PCV13 vaccine is formulated using a purified component of the bacteria's cell wall, which is combined with a nontoxic variant of diphtheria known as CRM197, serving as a carrier to enhance the immune response. This specific vaccine covers 13 different serotypes of Streptococcus pneumoniae, which are responsible for a majority of pneumococcal disease cases. The vaccine is administered via an intramuscular injection, and it is important to note that there are other pneumococcal vaccines available, such as the 15 valent vaccine (PCV15), which offers broader coverage by including additional serotypes. The use of the PCV13 vaccine is essential in preventing serious pneumococcal infections and protecting at-risk populations.
© Copyright 2025 Coding Ahead. All rights reserved.
The pneumococcal conjugate vaccine, 13 valent (PCV13), is indicated for the prevention of pneumococcal diseases caused by specific serotypes of Streptococcus pneumoniae. The following conditions and populations are explicitly recognized for vaccination:
The administration of the pneumococcal conjugate vaccine, 13 valent (PCV13), involves a series of procedural steps to ensure proper delivery and effectiveness of the vaccine:
Following the administration of the pneumococcal conjugate vaccine, 13 valent (PCV13), patients may experience mild side effects, such as soreness at the injection site, low-grade fever, or irritability, particularly in young children. These effects are generally short-lived and resolve without intervention. It is important for healthcare providers to educate patients or guardians about these potential reactions and to advise them on when to seek further medical attention. Additionally, patients should be informed about the importance of completing the vaccination series, if applicable, to ensure optimal protection against pneumococcal diseases. Documentation of the vaccination should be recorded in the patient's medical record, including the date of administration, vaccine lot number, and the site of injection.
| Short Descr | PCV13 VACCINE IM | Medium Descr | PCV13 VACCINE FOR INTRAMUSCULAR USE | Long Descr | Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use | Related Drugs | PREVNAR 13 | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Influenza, Pneumococcal Pneumonia, Hepatitis B, and Covid-19 Vaccines; Monoclonal Antibody Therapy Product | ASC Payment Indicator | Influenza vaccine; pneumococcal vaccine. | Type of Service (TOS) | V - Pneumococcal/Flu Vaccine | Berenson-Eggers TOS (BETOS) | O1G - Immunizations/Vaccinations | MUE | 1 | CCS Clinical Classification | 228 - Prophylactic vaccinations and inoculations |
| GA | Waiver of liability statement issued as required by payer policy, individual case | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | CR | Catastrophe/disaster related | GW | Service not related to the hospice patient's terminal condition | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GX | Notice of liability issued, voluntary under payer policy | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | JG | Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | JZ | Zero drug amount discarded/not administered to any patient | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | SA | Nurse practitioner rendering service in collaboration with a physician | SL | State supplied vaccine | TB | Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | U1 | Medicaid level of care 1, as defined by each state | U6 | Medicaid level of care 6, as defined by each state | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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Notes
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| 2016-01-01 | Changed | First appearance of change in codebook. |
| 2015-07-01 | Changed | Description Changed |
| 2011-01-01 | Changed | FDA Approval Pending status changed. Short description changed. |
| 2010-01-01 | Added | First appearance in code book in 2010. |
| 2009-10-01 | Added | - |
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