Product Lines: EHP, Priority Partners and USFHP.

Measurement Period: January 1 - December 31

Description:
The percent of persons 2 years old during the measurement period who receive the following immunizations by their 2nd birthday.

• 4 doses - PCV (Pneumococcal conjugate)
• 4 doses - DTaP (Diphtheria, tetanus and acellular pertussis)
• 3 doses - IPV (Polio)
• 3 doses - HepB (Hepatitis B)
• 3 doses - HiB (Haemophilus influenzae type B)
• 1 dose - MMR (Measles, mumps and rubella)
• 1 dose - VZV (Varicella - Chicken Pox)
• 1 dose - HepA (Hepatitis A)
• 2 doses - Influenza (Flu)
• 2 OR 3 doses*- RV (Rotavirus Monovalent – Rotarix (2 DOSE) – RV1) OR 3 doses*- RV (Rotavirus Pentavalent – RotaTeq (3 DOSE) – RV5)

*Rotavirus manufacture name (2) two-dose (GlaxoSmithKline - GSK) OR (3) three-dose (Merck) series.

Stratifications: Report stratification by race and ethnicity.

Measure Reporting: HealthChoice Performance Measure reporting for Priority Partners.  

Improvement Notation: Increased score indicates improvement.

Data Collection:

• ECDS.  

Initial Population:

• Measure Item Count: Person.
• Age: Persons who turn 2 years of age during the measurement period.
• Benefits: Medical.
• Continuous Enrollment: 365 days prior to the person’s second birthday and the second birthday.
• Allowable Gap: No more than one gap of ≤45 days during the measurement period. No gap on the second birthday.

Denominator:
The initial population minus denominator exclusions.

Numerator:
Numerator 1: Immunization status—DTaP. 
Persons who meet any of the following criteria on or before the second birthday:

• At least four DTaP vaccinations, with different dates of service. 
• Anaphylaxis due to the diphtheria, tetanus or pertussis vaccine.
• Encephalitis due to the diphtheria, tetanus or pertussis vaccine.

Numerator 2: Immunization status—IPV. 
Persons who meet either of the following criteria on or before the second birthday:

• At least three IPV vaccinations, with different dates of service. 
• Anaphylaxis due to the IPV vaccine.

Numerator 3: Immunization status—MMR. 
Persons who meet any of the following criteria:

• At least one MMR vaccination on or between the first and second birthdays.
• All of the following any time on or before the second birthday (on the same or different date of service). 
  
  • History of measles illness.
  • History of mumps illness.
  • History of rubella illness.
• Anaphylaxis due to the MMR vaccine on or before the second birthday.

Numerator 4: Immunization status—HiB. 
Persons who meet either of the following criteria on or before the second birthday: 

• At least three HiB vaccinations, with different dates of service. Do not count a vaccination administered prior to 42 days after birth.
• Anaphylaxis due to the HiB vaccine.

Numerator 5: Immunization status—Hepatitis B. 
Persons who meet any of the following criteria on or before the second birthday:

• At least three hepatitis B vaccinations, with different dates of service.
  • One of the three vaccinations may be a newborn hepatitis B vaccination during the 8-day period that begins on the date of birth and ends 7 days after the date of birth.
• History of hepatitis B illness.
• Anaphylaxis due to the hepatitis B vaccine.

Numerator 6: Immunization status—VZV. 
Persons who meet any of the following criteria:

• At least one VZV vaccination, with a date of service on or between the first and second birthdays.
• History of varicella zoster (e.g., chicken pox) illness on or before the second birthday. 
• Anaphylaxis due to the VZV vaccine on or before the second birthday.

Numerator 7: Immunization status—Pneumococcal conjugate. 
Persons who meet either of the following criteria on or before the second birthday: 

• At least four pneumococcal conjugate vaccinations, with different dates of service. Do not count a vaccination administered prior to 42 days after birth.
• Anaphylaxis due to the pneumococcal vaccine.

Numerator 8: Immunization status—Hepatitis A. 
Persons who meet any of the following criteria:

• At least one hepatitis A, with a date of service on or between the first and second birthdays.
• History of hepatitis A illness on or before the second birthday. 
• Anaphylaxis due to the hepatitis A vaccine on or before the second birthday.

Numerator 9: Immunization status—Rotavirus. 
Persons who meet any of the following criteria: 

• At least two doses of the two-dose rotavirus vaccine on different dates of service on or before the second birthday.
• At least three doses of the three-dose rotavirus vaccine on different dates of service on or before the second birthday. 
• At least one dose of the two-dose rotavirus vaccine and at least two doses of the three-dose rotavirus vaccine, all on different dates of service, on or before the second birthday. Do not count a vaccination administered prior to 42 days after birth.
• Anaphylaxis due to the rotavirus vaccine on or before the second birthday.

Numerator 10: Immunization status—Influenza. 
Persons who meet either of the following criteria on or before the second birthday: 

• At least two influenza vaccinations with different dates of service. Do not count a vaccination administered prior to 180 days after birth.
  
  • An influenza vaccination recommended for children 2 years and older (e.g., LAIV) administered on the second birthday meets criteria for one of the two required vaccinations.
• Anaphylaxis due to the influenza vaccine.

Numerator 11: Immunization status—Combination 3. 
Persons who are numerator compliant for DTaP, IPV, MMR, HiB, hepatitis B, VZV and pneumococcal indicators.

Numerator 12: Immunization status—Combination 7. 
Persons who are numerator compliant for DTaP, IPV, MMR, HiB, hepatitis B, VZV, pneumococcal, hepatitis A and rotavirus indicators.

Numerator 13: Immunization status—Combination 10. 
Persons who are numerator compliant for DTaP, IPV, MMR, HiB, hepatitis B, VZV, pneumococcal, hepatitis A, rotavirus and influenza indicators.

Summary of changes:
National Drug Code (NDC) has been added to the measures to identify self-administration of influenza vaccine.

Best Practice and Measure Tips

• Advise parents on the importance of completing each vaccine series.
  • Provide handouts.
  • Educate parents on vaccination and side effects.
  • Review immunization records at each visits and catch up with any missing immunizations.
• Office improvement opportunity
  • Place guidelines to schedule visits within the CDC guidelines timeframe. (https://www.cdc.gov/vaccines/hcp/imz-schedules/downloads/child/0-18yrs-child-combined-schedule.pdf)
  • Contact parents to re-schedule any missed appointment for their child’s vaccination.
  • Use measure codes and exclusion code listed below when submitting claims to make member compliant by administrative data.
• Hep B (One can be newborn between date of birth and 7 days). Document the first Hep B vaccine given at the hospital or at birth when applicable (if unavailable – name of hospital where child was born).
• DOCUMENT ANY PARENT REFUSAL FOR IMMUNIZATIONS. This does not exclude member from measure.
• The below count towards compliance for the vaccine.  Document with event date:
  • For DTaP: Encephalitis due to the vaccine.  
  • For ALL vaccines: 
    • Anaphylaxis due to the vaccine.
    • Evidence of the antigen or combination vaccine.
  • For hepatitis B, MMR, VZV and hepatitis A, count any of the following: 
    • Documented history of the illness.
• Must be done by 2nd birthday:  when scheduling check calendar and schedule prior to 2nd birthday.
• For rotavirus, if documentation does not indicate whether the two-dose schedule or three-dose schedule was used, a three-dose schedule is assumed.
• For combination vaccinations that require more than one antigen (DTaP, MMR), evidence of all antigens must be documented.
• LAIV (live attenuated influenza vaccine) only counts if administered ON the second birthday.

Acceptable documentation:

• A certificate of immunization prepared by an authorized health care provider or agency including the specific dates and types of immunizations administered.
• A note indicating the name of the specific antigen and immunization date.
  • Immunizations documented using a generic header (e.g., polio vaccine) or “IPV/OPV” can be counted as evidence of IPV.
  • Immunizations documented using a generic header or “DTaP/DTP/DT” can be counted as evidence of DTaP
• A note in the medical record indicating the member received the immunization "at delivery" or "in the hospital". Use the date of birth as the date administered.

Not Acceptable:

• A note the "member is up to date" with all immunizations but does not list the dates and names of all immunizations.
• Vaccines documented as Adult.
• Influenza: Do not count a vaccination administered prior to 6 months (180 days after birth.)
• DTaP, IPV, HiB, Pneumococcal conjugate, Rotavirus: Do not count a vaccination administered prior to 42 days after birth. 

Measure Exclusions

Denominator Exclusions:

• Persons in hospice or using hospice services any time during the measurement period.
• Persons who died any time during the measurement period.
• Persons who had a contraindication to a childhood vaccine on or before their second birthday:
  • Severe combined immunodeficiency 
  • Immunodeficiency 
  • HIV 
  • Lymphoreticular cancer, multiple myeloma or leukemia 
  • Intussusception
  • Organ and Bone marrow Transplants
• Laboratory claims (claims with POS code 81).

Exclusion Codes

Severe Combined Immunodeficiency 

• ICD-10-CM: D81.0, D81.1, D81.2, D81.9

Disorders of the Immune System (Immunodeficiency)

• ICD-10-CM: D80.0- D80.9, D81.0- D81.2, D81.4, D81.6, D81.7, D81.89, D81.9, D82.0- D82.4, D82.8, D82.9, D83.0-D83.2, D83.8, D83.9, D84.0, D84.1, D84.8, D84.81, D84.821, D84.822, D84.89, D84.9, D89.3, D89.810-D89.813, D89.82, D89.831-D89.835, D89.839, D89.89, D89.9
• HIV 
  • ICD-10-CM: B20, Z21
• HIV Type 2 
  • ICD-10-CM: B97.35 

Malignant Neoplasm of Lymphatic Tissue

• Lymphoreticular cancer ICD-10-CM:  C81.00- C81.49,C81.70- C81.79, C81.90- C81.99, C82.00- C82.69, C82.80- C82.99, C83.00-  C83.39, C83.50- C83.59, C83.70- C83.99, C84.40- C84.49, C84.60- C84.79, C84.7A, C84.90- C84.99, C84.A0- C84.A9, C84.Z0- C84.Z9, C85.10- C85.29, C85.80- C85.99, C86.0-C86.5, C88.4, C96.9, C96.Z*
• Multiple Myeloma ICD-10-CM: C90.00, C90.01, C90.02
• Leukemia ICD-10-CM: C90.10- C90.12, C91.00- C91.02, C91.10- C91.12, C91.30- C91.32, C91.40- C91.42, C91.50- C91.52, C91.60- C91.62, C91.90- C91.92, C91.A0- C91.A2, C91.Z0- C91.Z2, C92.00- C92.02, C92.10- C92.12, C92.20- C92.22, C92.40- C92.42, C92.50- C92.52, C92.60- C92.62, C92.90- C92.92, C92.A0- C92.A2, C92.Z0- C92.Z2, C93.00- C93.02, C93.10- C93.12, C93.30- C93.32, C93.90- C93.92, C93.Z0- C93.Z2, C94.00- C94.02, C94.20- C94.22, C94.30- C94.32, C94.80- C94.82, C95.00- C95.02, C95.10- C95.12, C95.90- C95.92*

Intussusception 

• ICD-10-CM: K56.1

Organ and Bone Marrow Transplants

• CPT: 32850, 32851, 32852, 32853, 32854, 32855, 32856, 33927, 33928, 33929, 33930, 33933, 33935, 33940, 33944, 33945, 44132, 44133, 44135, 44136, 44137, 44715, 44720, 44721, 47133, 47135, 47136, 47140, 47141, 47142, 47143, 47144, 47145, 47146, 47147, 48160, 48550, 48551, 48552, 48554, 48556, 50360, 50365, 50380 
• HCPCS: S2053, S2054, S2055, S2060, S2061, S2065, S2152 
• ICD-10-PCS: 02YA0Z0, 02YA0Z1, 02YA0Z2, 07YM0Z0, 07YM0Z1, 07YM0Z2, 07YP0Z0, 07YP0Z1, 07YP0Z2, 0BYC0Z0, 0BYC0Z1, 0BYC0Z2, 0BYD0Z0, 0BYD0Z1, 0BYD0Z2, 0BYF0Z0, 0BYF0Z1, 0BYF0Z2, 0BYG0Z0, 0BYG0Z1, 0BYG0Z2, 0BYH0Z0, 0BYH0Z1, 0BYH0Z2, 0BYJ0Z0, 0BYJ0Z1, 0BYJ0Z2, 0BYK0Z0, 0BYK0Z1, 0BYK0Z2, 0BYL0Z0, 0BYL0Z1, 0BYL0Z2, 0BYM0Z0, 0BYM0Z1, 0BYM0Z2, 0DY50Z0, 0DY50Z1, 0DY50Z2, 0DY60Z0, 0DY60Z1, 0DY60Z2, 0DY80Z0, 0DY80Z1, 0DY80Z2, 0DYE0Z0, 0DYE0Z1, 0DYE0Z2, 0FY00Z0, 0FY00Z1, 0FY00Z2, 0FYG0Z0, 0FYG0Z1, 0FYG0Z2, 0TY00Z0, 0TY00Z1, 0TY00Z2, 0TY10Z0, 0TY10Z1, 0TY10Z2, 0UY00Z0, 0UY00Z1, 0UY00Z2, 0UY10Z0, 0UY10Z1, 0UY10Z2, 0UY90Z0, 0UY90Z1, 0UY90Z2, 0WY20Z0, 0WY20Z1, 0XYJ0Z0, 0XYJ0Z1, 0XYK0Z0, 0XYK0Z1, 30230AZ, 30230C0, 30230G0, 30230G2, 30230G3, 30230G4, 30230U2, 30230U3, 30230U4, 30230X0, 30230X2, 30230X3, 30230X4, 30230Y0, 30230Y2, 30230Y3, 30230Y4, 30233AZ, 30233C0, 30233G0, 30233G2, 30233G3, 30233G4, 30233U2, 30233U3, 30233U4, 30233X0, 30233X2, 30233X3, 30233X4, 30233Y0, 30233Y2, 30233Y3, 30233Y4, 30240AZ, 30240C0, 30240G0, 30240G2, 30240G3, 30240G4, 30240U2, 30240U3, 30240U4, 30240X0, 30240X2, 30240X3, 30240X4, 30240Y0, 30240Y2, 30240Y3, 30240Y4, 30243AZ, 30243C0, 30243G0, 30243G2, 30243G3, 30243G4, 30243U2, 30243U3, 30243U4, 30243X0, 30243X2, 30243X3, 30243X4, 30243Y0, 30243Y2, 30243Y3, 30243Y4, 3E030U0, 3E030U1, 3E033U0, 3E033U1, 3E0J3U0, 3E0J3U1, 3E0J7U0, 3E0J7U1, 3E0J8U0, 3E0J8U1

*Please note that not all codes are listed here. For access to the complete set of codes related to CIS-E measure, contact your Provider Engagement Liaison or email [email protected]. 

Measure Codes

DTAP 

• CPT: 90697, 90698, 90700, 90723
• CVX: 20, 50, 106, 107, 110, 120, 146, 198
• Anaphylaxis Due to Diphtheria, Tetanus or Pertussis Vaccine SNOMED CT code: 428281000124107, 428291000124105
• Encephalitis Due to Diphtheria, Tetanus or Pertussis Vaccine SNOMED CT code: 192710009, 192711008, 192712001

IPV 

• CPT: 90697, 90698, 90713, 90723
• CVX: 10, 89, 110, 120, 146
• Anaphylaxis due to the IPV vaccine SNOMED CT code: 471321000124106

MMR 

• CPT: 90707, 90710
• CVX: 03, 94
• Measles and History of Measles: 
  • ICD-10-CM: B05.0, B05.1, B05.2, B05.3, B05.4, B05.81, B05.89, B05.9 
  • SNOMED CT US Edition: 14189004, 28463004, 60013002, 74918002, 161419000, 186561002, 186562009, 195900001, 240483006, 240484000, 359686005, 371111005, 406592004, 417145006, 424306000, 105841000119101, 293721000119101
  Mumps and History of Mumps:
  • ICD-10-CM: B26.0, B26.1, B26.2, B26.3, B26.81, B26.82, B26.83, B26.84, B26.85, B26.89, B26.9
  • SNOMED CT US Edition: 10665004, 17121006, 31524007, 31646008, 36989005, 40099009, 44201003, 63462008, 72071001, 75548002, 78580004, 89231008, 89764009, 161420006, 235123001, 236771002, 237443002, 240526004, 240527008, 240529006, 371112003, 1163539003, 105821000119107, 293721000119101
  Rubella and History of Rubella
  • ICD-10-CM: B06.00, B06.01, B06.02, B06.09, B06.81, B06.82, B06.89, B06.9
  • SNOMED CT US Edition: 10082001, 13225007, 19431000, 36653000, 51490003, 64190005, 79303006, 128191000, 161421005, 186567003, 186570004, 192689006, 231985001, 232312000, 240485004, 253227001, 1092361000119109, 1857005, 47082005, 111868009, 278968001, 302811004,1285608004, 105791000119104, 293721000119101, 1092351000119107
• Anaphylaxis due to the MMR vaccine SNOMED CT code: 471331000124109

HIB 

• CPT: 90644, 90647, 90648, 90697, 90698, 90748
• CVX: 17, 46, 47, 48, 49, 50, 51, 120, 146, 148, 198
• Anaphylaxis due to the HiB vaccine SNOMED CT code: 433621000124101

Hep B 

• CPT: 90697,90723, 90740, 90744, 90747, 90748
• CVX: 08, 44, 45, 51, 110, 146, 198
• HCPCS: G0010
• Hepatitis B and History of Hepatitis B
  • ICD-10-CM: B16.0, B16.1, B16.2, B16.9, B18.0, B18.1, B19.10, B19.11 
  • SNOMED CT US Edition:1116000, 13265006, 26206000, 38662009, 50167007, 53425008, 61977001, 66071002, 76795007, 111891008, 186624004, 186626002, 186639003, 235864009, 235865005, 235869004, 235871004, 424099008, 424340000, 429721005, 442134007, 442374005, 446698005, 838380002, 1230342001, 59851000119103, 153091000119109, 551621000124109, 16859701000119109, 713966008, 103611000119102
  Newborn Hepatitis B Vaccine Administered ICD10PCS: [3E0234Z] Introduction of Serum, Toxoid and Vaccine into Muscle, Percutaneous Approach 
• Anaphylaxis due to the hepatitis B vaccine SNOMED CT code: 428321000124101

Varicella VZV 

• CPT: 90710, 90716
• CVX: 21, 94
• Varicella Zoster and History of Varicella Zoster:
  • ICD-10-CM: B01.0, B01.11, B01.12, B01.2, B01.81, B01.89, B01.9, B02.0, B02.1, B02.21, B02.22, B02.23, B02.24, B02.29, B02.30, B02.31, B02.32, B02.33, B02.34, B02.39, B02.7, B02.8, B02.9
  • SNOMED CT US Edition: 4740000, 10698009, 21954000, 24059009, 31920006, 36292003, 38907003, 42448002, 55560002, 87513003, 161423008, 195911009, 230176008, 230198004, 230262004, 230536009, 232400003, 235059009, 240468001, 240470005, 240471009, 240472002, 240473007, 240474001, 309465005, 397573005, 400020001, 402897003, 402898008, 402899000, 410500004, 410509003, 421029004, 422127002, 422446008, 422471006, 422666006, 423333008, 423628002, 424353002, 424435009, 424801004, 424941009, 425356002, 426570007, 428633000, 713250002, 713733003, 713964006, 715223009, 838357005, 1163465001, 1163483009, 1179456002, 12551000132107, 12561000132105, 12571000132104, 98541000119101, 331071000119101, 681221000119108, 1087131000119102, 15678761000119105, 15678801000119102, 15678841000119100, 15680201000119106, 15680241000119108, 15681321000119100, 15681401000119101, 15685081000119102, 15685121000119100, 15685161000119105, 15936581000119108, 15936621000119108, 15989271000119107, 15989311000119107, 15989351000119108, 15991711000119108, 15991751000119109, 15991791000119104, 15992351000119104, 16000751000119105, 16000791000119100, 10491005, 186509002, 193190005, 240469009, 277644009, 416718008, 449783002, 733167008, 870310004, 870321008, 1142085005, 1144351000, 1144352007, 1254866003, 1263534009, 28721000119108, 2490001000004101, 15680281000119103, 15681361000119105, 15685201000119100, 15685241000119103, 15685281000119108, 15992271000119100, 15992311000119100, 16540531000119103
  Anaphylaxis due to the VZV vaccine SNOMED CT code: 471341000124104

Pneumococcal Conjugate PCV 

• CPT: 90670, 90671, 90677
• CVX: 109, 133, 152, 215, 216
• HCPCS: G0009
• Anaphylaxis due to the pneumococcal conjugate vaccine SNOMED CT code: 471141000124102

Hep A 

• CPT: 90633
• CVX: 31, 83, 85
• Hepatitis A and History of Hepatitis A:
  • ICD-10-CM: B15.0, B15.9
  • SNOMED CT US Edition: 16060001, 18917003, 25102003, 40468003, 43634002, 79031007, 111879004, 424758008, 428030001
• Anaphylaxis due to the hepatitis A vaccine SNOMED CT code 471311000124103

Rotavirus 

• Rotavirus (2 Dose) 
  • CPT: 90681
  • CVX: 119 
• Rotavirus (3 Dose)
  • CPT: 90680
  • CVX: 116, 122
• Anaphylaxis due to the rotavirus vaccine SNOMED CT code: 428331000124103

Influenza 

• CPT: 90655, 90656, 90657, 90658, 90661, 90674, 90685, 90686, 90687, 90688, 90689, 90756
• CVX: 88, 140, 141, 150, 153, 155, 158, 161, 171, 186, 320
• Anaphylaxis due to the influenza vaccine SNOMED CT code: 471361000124100
• NDC: 66019011251

Influenza LAIV

• CPT: 90660, 90672
• CVX: 111, 149, 333