Update: Medicare Part B Coverage for Pneumococcal Vaccination

In response to Advisory Committee on Immunization Practices’ (ACIP’) recent update to guidelines for pneumococcal vaccines, which now recommend the administration of two different pneumococcal vaccinations, the Centers for Medicare & Medicaid Services (CMS) is updating Medicare Part B requirements.

For services furnished on or after May, 1, 1981 through September 18, 2014, Medicare Part B covered pneumococcal pneumonia vaccine and its administration to persons at high risk for the disease, including:

  • Age 65 and older
  • Immunocompetent adults with chronic illness
  • Individuals with compromised immune systems

Coverage for revaccination was covered only to persons for whom pneumococcal posed the greatest threat, and only if at least five years had passed since the last pneumococcal vaccination.

Effective for dates of service on or after September 19, 2014, Medicare will cover:

  • An initial pneumococcal vaccine to all Medicare beneficiaries who have never received the vaccine under Medicare Part B; and
  • A different, second pneumococcal vaccine one year after the first vaccine.

Prior pneumococcal vaccination history should be taken into consideration. For example, if a patient age 65 or older received the 23-valent pneumococcal polysaccharide vaccine a year or more ago, then the 13-valent pneumococcal conjugate vaccine should be administered next, as the second in the series of the two recommended pneumococcal vaccinations.

Note: A Medicare patient may receive the vaccine upon request without a physician’s order, and without physician supervision.

Source: MM9051

Renee Dustman

Renee Dustman

Executive Editor at AAPC
Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.
Renee Dustman

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Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

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