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Childhood Immunizations

EHP, Priority Partners, and USFHP. Children who turned 2 years old during the measurement year. 

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

Best Practice and Measure Tips

  • 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, AS WELL AS ANAPHYLACTIC REACTIONS. This does not exclude member from measure.
  • Document all seropositives and illness history of chicken pox, hepatitis, measles, mumps, and rubella with event date.
    • History of VZV or MMR on or before child’s 2nd birthday.
    • Must be done by 2nd birthday: when scheduling check calendar and schedule prior to 2nd 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 of the specific antigen and immunization.
  • 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.

For combination vaccinations that require more than one antigen (DTaP, MMR), evidence of all antigens must be documented.LAIV only counts if administered ON the second birthday.

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.

Measure Exclusions

Required Exclusions: Hospice.

Optional Exclusions: Any of the following on or before the child's second birthday:

  • Any vaccine - Anaphylactic reaction to the vaccine or its components
  • DTaP-Encephalopathy
  • MMR, VZV and influenza-Immunodeficiency, HIV, Lymphoreticular cancer, multiple myeloma or leukemia -Anaphylactic reaction to neomycin.
  • Rotavirus-Severe combined immunodeficiency, history of intussusception
  • IPV-Anaphylactic reaction to streptomycin, polymyxin B or neomycin
  • Hepatitis B-Anaphylactic reaction to common baker's yeast

Contraindicated children will only be excluded if not compliant.

Measure Codes

  • DTAP
    • CPT: 90698, 90700, 90721, 90723
    • CVX: 20, 50, 106, 107, 110, 120
  • HIB
    • CPT: 90644, 90645, 90646, 90647, 90648, 90698, 90721, 90748
    • CVX: 17, 46, 47, 48, 49, 50, 51, 120, 148
  • Hep B
    • CPT: 90723, 90740, 90744, 90747-8
    • CVX: 08, 44, 45, 51, 110
    • HCPCS: G0010
    • ICD-10: B16.0, B16.1, B16.2, B16.9, B17.0, B18.0, B18.1, B19.10, B19.11, Z22.51
  • IPV
    • CPT: 90698, 90713, 90723
    • CVX: 10, 89, 110, 120
  • MMR
    • CPT: 90704-, 90708, 90710
    • CVX: 05, 03, 94, 04, 07, 06
    • ICD-10: B05.0- B05.4, B05.81, B05.89, B05.9, B26.0, B26.1, B26.2, B26.3, B26.81, B26.82. B26.83, B26.84, B26.85, B26.89, B26.9, B06.00- B06.02, B06.09, B06.81, B06.82, B06.89, B06.9
  • Pneumococcal Conjugate PCV
    • CPT: 90670
    • CVX: 133, 152
    • HCPCS: G0009
  • Varicella VZV
    • CPT: 90710, 90716
    • CVX: 21, 94
    • ICD-10: 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- B02.34, B02.39, B02.7, B02.8, B02.9
  • Hep A
    • CPT: 90633
    • CVX: 31, 83, 85
    • ICD-10: B15.0, B15.9
  • Influenza
    • CPT: 90655, 90657, 90660, 90662, 90673, 90685, 90686- 90689, 90672
    • CVX: 88, 135, 140, 141, 150, 153, 155, 158, 161, 111, 149
    • HCPCS: G0008
  • Rotavirus
    • Rotavirus (2 Dose)
      • CPT: 90681
      • CVX: 119 Rotavirus
    • Rotavirus (3 Dose)
      • CPT: 90680
      • CVX: 116, 122