Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare
On March 16, 2023 CMS issued Transmittal 11905 – same title as this blog. The effective date of these revisions was October 19, 2022 with implementation date of April 17, 2023.
Effective July 1, 2021, CMS updated Medicare coverage requirements to align with ACIP recommendations. ACIP recommends that adults age ≥65 years who have not previously received a 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 Pneumococcal Polysaccharide Vaccine (PPSV) 23.
For those adults aged 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.
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.
For adults who have 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.
Effective October 19, 2022, CMS updated the Medicare coverage requirements to align with ACIP recommendations. While much of the previous recommendation remains unchanged, for adults age ≥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 completion of 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 have 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 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.
You’ll find the corresponding MLN Matters here.
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