April 28, 2000

Medi-783-00

TO: ALL MEDICARE PROVIDERS

SUBJECT: COVERAGE OF PNEUMOCOCCAL PNEUMONIA VACCINE (PPV)

PRIMARY INTEREST: BUSINESS OFFICE MANAGERS , MEDICAL DIRECTORS

EFFECTIVE DATE: DATES OF SERVICE ON OR AFTER JULY 1, 2000

The Health Care Financing Administration has announced that effective with dates of service on or after July 1, 2000, Medicare will not require for coverage purposes, that the PPV vaccine and its administration be ordered by a doctor of medicine or osteopathy. Therefore, the beneficiary may receive the vaccine upon request without a physician's order and without physician supervision.

An initial vaccine may be administered only to persons at high risk of pneumococcal disease. Revaccination may be administered only to persons at high risk of serious pneumococcal infection and those likely to have rapid decline in pneumococcal antibody levels, provided that at least 5 years have passed since receipt of a previous dose of PPV.

Those administering the vaccine should not require the patient to present an immunization record prior to PPV administration, nor should they feel compelled to review the patient's complete medical record. If it is not available. If the patient is competent, rely on the patient's verbal history to determine prior vaccination status. If the patient is uncertain about their vaccination history for the past 5 years, the vaccine should be given. If the patient is certain they received a vaccination more than 5 years ago, revaccination is not appropriate unless the patient is at high risk. The high risk factors have been previously published by HCFA.

THIS BULLETIN SHOULD BE SHARED WITH ALL HEALTH CARE PRACTITIONERS AND MANAGERIAL MEMBERS OF THE PROVIDER STAFF. NO COST COPIES ARE ALSO AVAILABLE FROM OUR WEB SITE AT riverbendgba.com

Please refer any questions to our office at (423) 755-5950.