Product Lines:
EHP, Priority Partners and USFHP.

Eligible Population:
Children who turned 2 years old during the measurement year.

Definition:
The percent of children 2 years old during the measurement year who receive the following immunizations by their 2nd birthday.

Combo 3:

• 4 doses – DTaP, PCV
• 3 doses – Hib, IPV, Hep B
• 1 dose – MMR, VZV (On or between child’s 1st and 2nd birthday)

Combo 10 (includes all Combo 3 immunizations above plus the following):

• 1 dose – Hep A (On or between child’s 1st and 2nd birthday)
• 2 doses – Rotavirus Monovalent (Rotarix-RVl) OR 3 doses – Rotavirus Pentavalent (RotaTeq-TlV)
• 2 doses – Influenza

Continuous Enrollment:

• 365 days prior to the child’s second birthday.

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/schedules/hcp/imz/catchup.html)
  • 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, assume a three-dose schedule.
• 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

Required Exclusions:

• Members in hospice or using hospice services anytime during the measurement year.
• Members who died any time during the measurement year.
• Members 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

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

Measure Codes

• DTAP 
  • CPT: 90697, 90698, 90700, 90723
  • CVX: 20, 50, 106, 107, 110, 120, 146
  • 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
  • ICD-10-CM: 
    • History of measles illness: B05.0- B05.4, B05.81, B05.89, B05.9
    • History of mumps illness: B26.0- B26.3, B26.81- B26.85, B26.89, B26.9
    • History of rubella illness: B06.00- B06.02, B06.09, B06.81, B06.82, B06.89, B06.9
    • 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
  • 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
  • HCPCS: G0010
  • History of hepatitis B illness ICD-10-CM: B16.0, B16.1, B16.2, B16.9, B17.0, B18.0, B18.1, B19.10, B19.11 
  • 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
  • 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- B02.24, B02.29- B02.34, B02.39, B02.7, B02.8, B02.9
  • Anaphylaxis due to the VZV vaccine SNOMED CT code: 471341000124104
• Pneumococcal Conjugate PCV 
  • CPT: 90670, 90671
  • CVX: 109,133, 152, 215
  • HCPCS: G0009
  • Anaphylaxis due to the pneumococcal conjugate vaccine SNOMED CT code: 471141000124102
• Hep A 
  • CPT: 90633
  • CVX: 31, 83, 85
  • History of hepatitis A illness  ICD-10-CM: B15.0, B15.9
  • 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, 90657, 90661, 90673, 90674, 90685- 90689, 90756
  • CVX: 88,140, 141, 150, 153, 155, 158, 161, 171, 186
  • HCPCS: G0008
  • Anaphylaxis due to the influenza vaccine SNOMED CT code: 471361000124100
• Influenza LAIV
  • CPT: 90660, 90672
  • CVX: 111, 149
  • Anaphylaxis due to the influenza vaccine SNOMED CT code: 471361000124100