Question 1

What is HCPCS code S0195?

Accepted Answer

HCPCS code S0195 is "Pneumo vaccine 5-9 yrs". Pneumococcal conjugate vaccine, polyvalent, intramuscular, for children from five years to nine years of age who have not previously received the vaccine

Question 2

What category is S0195 in?

Accepted Answer

S0195 belongs to HCPCS Category S (Temporary National Codes (Non-Medicare)).

Question 3

When should I use HCPCS code S0195?

Accepted Answer

Use S0195 when billing for pneumo vaccine 5-9 yrs. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is S0195 covered by Medicare?

Accepted Answer

Coverage for S0195 (Pneumo vaccine 5-9 yrs) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for S0195?

Accepted Answer

Documentation for S0195 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).