CMS Updated Medical Coverage Requirements

The Centers for Disease Control and Prevention (CDC) has issued new recommendations for the pneumococcal vaccine in adults over the age of 65.  The CDC recommends that providers now use two pneumococcal vaccines for adults aged ≥65.  These vaccinations are 13-Valent Pneumococcal Conjugate Vaccine (PCV13) and 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23).  The CDC recommendations are located at www.cdc.gov/vaccines/vpd-vac/pneumo/default.htm.

CMS has updated the Medicare coverage requirements to align with this recommendation.  These Medicare coverage requirements were implemented on February 2, 2015 as posted in the MLN Matters document: MM9051.

Please visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9051.pdf to see that specific MLN Matters document.

CMS has instructed providers to continue to code item O0300 as instructed in the current RAI User’s Manual.