Page 64 - Medicare Benefit Policy Manual

Effective October 19, 2022, CMS adds the following coverage
requirements to align with additional ACIP recommendations and
further clarifies the 2021 update.

For adults aged ≥65 years who completed their vaccine series with
both PCV13 and PPSV23, but no PPSV23 was received at age ≥65,
either one dose of PCV20 is recommended at least 5 years after the
last pneumococcal vaccine dose, or complete the recommended
PPSV23 series as previously recommended.

Shared clinical decision-making is recommended regarding
administration of PCV20 for adults age ≥65 years who completed
their vaccine series with both PCV13 and PPSV23, and PPSV was
received at age ≥65. If a decision to administer PCV20 is made, a
dose of PCV20 is recommended at least 5 years after the last
pneumococcal vaccine dose.

In addition, adults age ≥65 years and adults age 19-64 years with
certain underlying medical conditions or other risk factors who
received PCV13 only are recommended to receive a dose of PCV20
at least 1 year after the PCV13 dose, or PPSV23 as previously
recommended to complete their pneumococcal vaccine series.

ACIP recommends that adults age 19-64 years with certain
underlying medical conditions or other risk factors who have
received both PCV13 and PPSV23 with incomplete vaccination
status are recommended to complete their pneumococcal vaccine
series by receiving either a dose of PCV20 at least 5 years after the
last pneumococcal vaccine dose, or PPSV23 as previously
recommended.

Those administering the vaccine should not require the
patient to present an immunization record prior to
administering the pneumococcal vaccine, nor should they feel
compelled to review the patient’s complete medical record if
it is not available. Instead, provided that the patient is
competent, it is acceptable to rely on the patient’s verbal
history to determine prior vaccination status.

Medicare does not require for coverage purposes that a
doctor of medicine or osteopathy order the vaccine.
Therefore, the beneficiary may receive the vaccine upon
request without a physician’s order and without physician
supervision.

B. Hepatitis B Vaccine