CMS Modifies it’s Pneumococcal Vaccine Policy
January 21, 2015 10:57 AM
The Centers for Medicare & Medicaid Services (CMS) has issued Change Request 9050 which revises CMS’ pneumococcal vaccination policy for Medicare beneficiaries. This decision is based on the recent Advisory Committee on Immunization Practices (ACIP) recommendations that both the Pneumococcal Polysaccharide Vaccine 23 (PPSV23) and the Pneumococcal Conjugate Vaccine 13 (PCV13) is to be given to adults 65 and older, and younger individuals at risk for pneumococcal pneumonia. Generally, the pneumococcal vaccine was covered once in a beneficiary’s lifetime, with revaccinations covered for those at highest risk if 5 years have passed since the last vaccination, or if the beneficiary’s vaccination history was unknown.
For adults 65 years of age or older with no previous pneumococcal vaccinations, the (ACIP) recommends a dose of Pneumococcal Conjugate Vaccine 13 (PCV13) followed by a dose of Pneumococcal Polysaccharide Vaccine (PPSV23) 6 to 12 months later. Adults 65 years of age or older who have received one or more doses of PPSV23 but have not received PCV13 be given a dose of PCV13 at least 1 year after receipt of the most recent PPSV23 dose.
CMS is updating the Medicare coverage requirements to align with the updated ACIP recommendations. An initial pneumococcal vaccine may be administered to all Medicare beneficiaries who have never received a pneumococcal vaccine under Medicare Part B. A different, second pneumococcal vaccine may be administered 1 year after the first vaccine was administered (i.e., 11 full months have passed following the month in which the last pneumococcal vaccine was administered).
To view the Change Request, please click here.
To view the APIC recommended pneumococcal vaccine schedule, please click here.