pneumococcal vaccine

New Coverage Updates for Pneumococcal Vaccinations

Prior to 2015, 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. The Advisory Committee on Immunization Practices (ACIP) recently updated its guidelines regarding pneumococcal vaccines. The ACIP recommends administration of two different pneumococcal vaccinations.
CMS updated the Medicare coverage requirements to more closely 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). 
Note: The pneumococcal vaccine and its administration are covered under Medicare Part B. The pneumococcal vaccine is not a Part D-covered drug.

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