CMS Issues Updated Medicare Reimbursement Guidelines for Pneumovac

In September, the Centers for Disease Control (CDC) updated guidance related to pneumococcal vaccination for adults. The New York State Department of Health(DOH) also issued guidance in accordance with the updated CDC guidelines. The guidance now recommends a two-step process for pneumococcal vaccination in adults.The updated guidelines requires an additional vaccination be provided, however, Medicare Part B provided reimbursement for only one vaccine. The Medicare Part B reimbursement guidelines have been updated to provide for payment for an additional vaccination under certain conditions. One of the stipulations is that the vaccinations are given a year apart, with at least 11 full calendar months in between injections. For additional reimbursement rules or NYS DOH health advisory related to pneumococcal vaccination, follow the links below: 

• NYS Health Advisory – Pneumococcal Vaccination for Adults
• Modifications to Medicare Part B Coverage of Pneumococcal Vaccinations 

Contact: Michelle Synakowski, msynakowski@leadingageny.org, 518-867-8850