Medicare Coverage of Pneumococcal Vaccines

The Department of Health released a Thurs., Feb. 19 Information Message to inform hospitals and long term care facilities that the Centers for Medicare and Medicaid Services (CMS) has updated Medicare Part B coverage. Effective Mon., Feb. 2, 2015 for claims with dates of service on and after Sept. 19, 2014, Medicare Part B will cover a second dose of pneumococcal vaccine for all Medicare beneficiaries.

An initial pneumococcal vaccine may be administered to all Medicare beneficiaries who have never received a pneumococcal vaccine under Medicare Part B, and a different, second pneumococcal vaccine may be administered one year later.

The recommendation for a second dose is based on the findings from Advisory Committee on Immunization Practices (ACIP), which may be reviewed by clicking here. Specifically, the ACIP recommends that the vaccine be routinely administered to individuals aged 65 years and older, and routine administration in persons aged 19-64 years with immuno-compromising conditions or at high risk for invasive pneumococcal disease and its complications.

The CMS guidance can be found in Medlearn Matters article # MM9051. 

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827