MedicaidCoverageMedium impact
BT2023144: IHCP expands coverage for Prevnar 20 to the pediatric population
Indiana Medicaid (IHCP)·IN · Family Medicine, Pediatrics, Internal Medicine·Medical Policy
Effective date
Apr 27, 2023
We identified it
Jun 19, 2026
Summary
IHCP (Indiana Medicaid) expanded coverage of Prevnar 20 vaccine (CPT 90677) to children as young as 6 weeks old, effective April 27, 2023. For pediatric patients ages 6 weeks through 18 years, the vaccine itself is reimbursed at $0 due to VFC program availability, with only administration fees covered.
Action Required
Immediately: Update billing system to allow CPT 90677 for patients as young as 6 weeks old for Indiana Medicaid patients. For pediatric patients ages 6 weeks through 18 years, bill only the administration fee (vaccine reimbursed at $0 due to VFC program). Verify quantity limits: 1 dose per lifetime for ages 6+, 4 doses per lifetime for ages 6 weeks through 5 years. Claims denied in error for age compatibility will be automatically reprocessed starting November 29, 2023.