Pneumovax Coding

The Virginia Health Care Association recently received a communication from Cil Bullard, RN, CPC, Virginia RAI/OASIS Coordinator with the Office of Licensure and Certification in regards to Pneumovax Coding:

The Centers for Disease Control and Prevention (CDC) along with recommendations from the Advisory Committee on Immunization Practices (ACIP) has issued new requirements for the pneumococcal vaccine in adults over the age of 65.  They recommend 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).

CMS is updating the Medicare coverage requirements to align with the updated ACIP recommendation. Effective for dates of service on or after September 19, 2014, (and upon implementation of CR9051), Medicare will cover:

  • An initial pneumococcal vaccine to all Medicare beneficiaries who have never received the vaccine under Medicare Part B; and
  • A different, second pneumococcal vaccine one year after the first vaccine was administered (that is, 11 full months have passed following the month in which the last pneumococcal vaccine was administered).

These Medicare coverage requirements are implemented on February 2, 2015 as posted in the MLN Matters document: MM9051.  

Please see the attached.

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