PCV21 VACCINE IM
Products billed under this code include Capvaxive.
Payment limit per 0.5 ML, by effective quarter, 4Q24 to 4Q26. Gaps mean the code was not in that quarter’s file, or CMS gave no payment limit.Products billed under 90684
From the 4Q26 NDC–HCPCS crosswalk. “Limit / pkg” is the 4Q26 payment limit times the billing units in one package.
| Product | Labeler | NDC | Units / pkg | Limit / pkg |
|---|---|---|---|---|
| Capvaxive | Merck | 00006-4347-01 | 1 | $344.252 |
| Capvaxive | Merck | 00006-4347-02 | 10 | $3,442.52 |
Every quarter
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $344.252 | $0.00 | 0.5 ML | PCV21 VACCINE IM | v1, posted September 17, 2026 |
| 3Q26 | $344.252 | $0.00 | 0.5 ML | PCV21 VACCINE IM | v1, posted September 15, 2026 |
| 2Q26 | $344.252 | $0.00 | 0.5 ML | PCV21 VACCINE IM | v1, posted September 15, 2026 |
| 1Q26 | $344.252 | +$16.359 | 0.5 ML | PCV21 VACCINE IM | v1, posted September 15, 2026 |
| 4Q25 | $327.893 | $0.00 | 0.5 ML | PCV21 VACCINE IM | v1, posted September 8, 2026 |
| 3Q25 | $327.893 | $0.00 | 0.5 ML | PCV21 VACCINE IM | v1, posted March 10, 2026 |
| 2Q25 | $327.893 | $0.00 | 0.5 ML | PCV21 VACCINE IM | v1, posted March 10, 2026 |
| 1Q25 | $327.893 | $0.00 | 0.5 ML | PCV21 VACCINE IM | v1, posted December 19, 2025 |
| 4Q24 | $327.893 | – | 0.5 ML | PCV21 VACCINE IM | v1, posted June 11, 2025 |
“Change” is the difference from the previous quarter, shown only when both quarters have a payment limit and the billing unit is the same. “vs. last quarter” and “vs. a year ago” follow the same rule.
CMS source files
- 4Q26: 2026-09-17_october-2026-medicare-part-b-payment-limit-files-final.zipposted September 17, 2026
- 4Q26: 2026-09-17_october-2026-ndc-hcpcs-crosswalk-final.zipposted September 17, 2026
- 3Q26: 2026-09-15_july-2026-medicare-part-b-payment-limit-files.zipposted September 15, 2026
- 2Q26: 2026-09-15_april-2026-medicare-part-b-payment-limit-files-final-file.zipposted September 15, 2026
- 1Q26: 2026-09-15_january-2026-medicare-part-b-payment-limit-files.zipposted September 15, 2026
- 4Q25: 2026-09-08_october-2025-asp-pricing-final-file.zipposted September 8, 2026
- 3Q25: 2026-03-10_july-2025-asp-pricing-file.zipposted March 10, 2026
- 2Q25: 2026-03-10_april-2025-asp-pricing-file.zipposted March 10, 2026
- 1Q25: 2025-12-19_january-2025-asp-pricing-file-03-11-25-final-file.zipposted December 19, 2025
- 4Q24: 2025-06-11_october-2024-asp-pricing-file.zipposted June 11, 2025