Page 62 - Medicare Benefit Policy Manual

410.57 authorize Medicare coverage under Part B for
pneumococcal vaccine and its administration.

For services furnished on or after May 1, 1981 through
September 18, 2014, the Medicare Part B program covered
pneumococcal pneumonia vaccine and its administration
when furnished in compliance with any applicable State law
by any provider of services or any entity or individual with a
supplier number. Coverage included an initial vaccine
administered only to persons at high risk of serious
pneumococcal disease (including all people 65 and older;
immunocompetent adults at increased risk of pneumococcal
disease or its complications because of chronic illness; and
individuals with compromised immune systems), with
revaccination administered only to persons at highest risk of
serious pneumococcal infection and those likely to have a
rapid decline in pneumococcal antibody levels, provided that
at least 5 years had passed since the previous dose of
pneumococcal vaccine.

Those administering the vaccine did not require the patient to
present an immunization record prior to administering the
pneumococcal vaccine, nor were they compelled to review
the patient’s complete medical record if it was not available,
relying on the patient’s verbal history to determine prior
vaccination status.

Effective for claims with dates of service on and after
September 19, 2014, an initial pneumococcal vaccine may be
administered to all Medicare beneficiaries who have never
received a pneumococcal vaccination 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).

Effective July 1, 2000, Medicare no longer required for
coverage purposes that a doctor of medicine or osteopathy
order the vaccine. Therefore, a beneficiary could receive the
vaccine upon request without a physician’s order and without
physician supervision.

2. Coverage Requirements:

Effective July 1, 2021, the Centers for Medicare & Medicaid
Services (CMS) updated the Medicare coverage