CPT 90677 Medicare ASP Payment Limit 2026
Medicare's Part B payment limit for CPT 90677 is $361.42 per billing unit (1 dose) in the October 2026 ASP file, up 15.5% from $312.90 in 2025.
- Per 1 dose
- $361.42
- vs. 2025
- +15.5%
- Commercial national avg.
- $318.09
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| Code | Month | Year | Payment Limit | Description |
|---|---|---|---|---|
| 90677 - CPT | Jan | 2025 | $298.04 | Pneumonia Vaccine Solution, Solution For The Pneumococcal Vaccine Injection. This Vaccination Is Used To Help Prevent Pneumonia. |
| 90677 - CPT | Apr | 2025 | $312.90 | Pneumonia Vaccine Solution, Solution For The Pneumococcal Vaccine Injection. This Vaccination Is Used To Help Prevent Pneumonia. |
| 90677 - CPT | Jul | 2025 | $312.90 | Pneumonia Vaccine Solution, Solution For The Pneumococcal Vaccine Injection. This Vaccination Is Used To Help Prevent Pneumonia. |
| 90677 - CPT | Oct | 2025 | $312.90 | Pneumonia Vaccine Solution, Solution For The Pneumococcal Vaccine Injection. This Vaccination Is Used To Help Prevent Pneumonia. |
| 90677 - CPT | Jan | 2026 | $312.90 | Pneumonia Vaccine Solution, Solution For The Pneumococcal Vaccine Injection. This Vaccination Is Used To Help Prevent Pneumonia. |
| 90677 - CPT | Apr | 2026 | $312.90 | Pneumonia Vaccine Solution, Solution For The Pneumococcal Vaccine Injection. This Vaccination Is Used To Help Prevent Pneumonia. |
| 90677 - CPT | Jul | 2026 | $341.00 | Pneumonia Vaccine Solution, Solution For The Pneumococcal Vaccine Injection. This Vaccination Is Used To Help Prevent Pneumonia. |
| 90677 - CPT | Oct | 2026 | $361.42 | Pneumonia Vaccine Solution, Solution For The Pneumococcal Vaccine Injection. This Vaccination Is Used To Help Prevent Pneumonia. |
90677 payment limit by quarter
Each row is one quarterly CMS ASP file. Change is against the quarter before.
| Quarter | Payment limit per 1 dose | Change |
|---|---|---|
| October 2026 | $361.42 | +6.0% |
| July 2026 | $341.00 | +9.0% |
| April 2026 | $312.90 | No change |
| January 2026 | $312.90 | No change |
| October 2025 | $312.90 | No change |
| July 2025 | $312.90 | No change |
| April 2025 | $312.90 | +5.0% |
| January 2025 | $298.04 | - |
The payment limit is Medicare's allowed amount per billing unit: the average sales price plus the statutory add-on. Medicare generally pays 80% of it after the Part B deductible, and the patient's coinsurance covers the rest. CMS recalculates it every quarter from manufacturer-reported sales.
90677: Medicare vs. commercial national average
The commercial national average for 90677, the mean of what BCBS, UnitedHealthcare, Aetna and Cigna publish nationwide, is $318.09 per 1 dose, 88% of Medicare's $361.42.
- BCBS $303.52
- UnitedHealthcare $294.96
- Aetna $349.51
- Cigna $324.38
A national average, not a local rate: each payer's figure averages the unmodified, in-network professional rates it publishes for 90677 across the country in its transparency files. Contracted rates vary widely by market, provider and plan. Medicare's figure is its current ASP payment limit per billing unit. Payers may bill the drug in a different unit, so compare the two with care.
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See what state Medicaid programs pay for 90677
50 state Medicaid agencies publish their own physician fee schedule. The 90677 page shows real published rates for several of them free, with effective dates and official sources.
17,674 codes and 974,327 published rates, taken from the files the state agencies publish themselves.
Methodology
Rates are sourced from CMS Part B Drug Average Sales Price (ASP) pricing files, published quarterly. Each HCPCS payment limit reflects the calculated ASP plus the statutory add-on for that quarter.
View CMS Part B ASP Pricing Files