Page 63 - Medicare Benefit Policy Manual

requirements to align with ACIP recommendations. Adults
age ≥65 years who have not previously received
pneumococcal conjugate vaccine (PCV) or whose previous
vaccination history is unknown should receive 1 dose of
PCV (either PCV20 or PCV15). When PCV15 is used, it
should be followed by a dose of 23-valent pneumococcal
polysaccharide vaccine (PPSV23).

For those adults age 19–64 years with certain underlying
medical conditions or other risk factors who have not
previously received PCV or whose previous vaccination
history is unknown should receive 1 dose of PCV (either
PCV20 or PCV15). When PCV15 is used, it should be
followed by a dose of PPSV23. Underlying medical
conditions or other risk factors include alcoholism, chronic
heart disease, chronic liver disease, chronic lung disease,
cigarette smoking, diabetes mellitus, cochlear implant,
cerebrospinal fluid leak, congenital or acquired asplenia,
sickle cell disease or other hemoglobinopathies, chronic
renal failure, congenital or acquired immunodeficiencies,
generalized malignancy, HIV infection, Hodgkin disease,
iatrogenic immunosuppression, leukemia, lymphoma,
multiple myeloma, nephrotic syndrome and solid organ
transplant.

Clinical guidance shows that when PCV15 is used, the
recommended interval between administration of PCV15 and
PPSV23 is ≥1 year. A minimum interval of 8 weeks can be
considered for adults with an immunocompromising
condition, cochlear implant, or cerebrospinal fluid leak to
minimize the risk for invasive pneumococcal disease caused
by serotypes unique to PPSV23 in these vulnerable groups.
Immunocompromising conditions include chronic renal
failure, congenital or acquired immunodeficiencies,
generalized malignancy, HIV infection, Hodgkin disease,
iatrogenic immunosuppression, leukemia, lymphoma,
multiple myeloma, nephrotic syndrome, solid organ
transplant, congenital or acquired asplenia, sickle cell
disease, or other hemoglobinopathies.

For adults who only received PPSV23, they may receive a
PCV (either PCV20 or PCV15) ≥1 year after their last
PPSV23 dose. When PCV15 is used in those with history of
PPSV23 receipt, it need not be followed by another dose of
PPSV23.