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Johns Hopkins Health Plans

CIS-E - Childhood Immunizations

NCQA retired the Administrative and Hybrid reporting methods. Only the ECDS Method will be used for this measure.

Product Lines:
EHP, Priority Partners and USFHP.

Eligible Population:
Children who turned 2 years old during the measurement year. This includes HealthChoice Performance Measure reporting for Priority Partners only for combo 3 and 10.

Definition:
The percent of children 2 years old during the measurement year 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.

The measure calculates a rate for each vaccine and three combination rates.

Combination 3
Members who are numerator compliant for DTaP, IPV, MMR, HiB, hepatitis B, VZV and pneumococcal indicators.

Combination 7
Members who are numerator compliant for DTaP, IPV, MMR, HiB, hepatitis B, VZV, pneumococcal, hepatitis A and rotavirus indicators.

Combination 10
Members who are numerator compliant for DTaP, IPV, MMR, HiB, hepatitis B, VZV, pneumococcal, hepatitis A, rotavirus and influenza indicators.

New for CIS-E Measure: Stratification by race and ethnicity.

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
  • 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

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
    • Organ and Bone marrow Transplants

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: 48552, 44721, 44720, 47147, 47146, 33944, 33933, 32856, 32855, 48551, 47145, 47144, 47143, 44715, 33940, 33930, 44132, 44133, 47133, 47140, 47141, 47142, 48550, 32850, 33945, 33935, 33927, 44135, 44136, 47135, 47136, 32854, 32853, 32852, 32851, 48160, 33928, 33929, 44137, 48556, 50365, 50360, 50380, 48554
    • HCPCS: S2061, S2055, S2060, S2065, S2152, S2054, S2053
    • 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, 30230G1, 30230G2, 30230G3, 30230G4, 30230U2, 30230U3, 30230U4, 30230X0, 30230X1, 30230X2, 30230X3, 30230X4, 30230Y0, 30230Y1, 30230Y2, 30230Y3, 30230Y4, 30233AZ, 30233C0, 30233G0, 30233G1, 30233G2, 30233G3, 30233G4, 30233U2, 30233U3, 30233U4, 30233X0, 30233X1, 30233X2, 30233X3, 30233X4, 30233Y0, 30233Y1, 30233Y2, 30233Y3, 30233Y4, 30240AZ, 30240C0, 30240G0, 30240G1, 30240G2, 30240G3, 30240G4, 30240U2, 30240U3, 30240U4, 30240X0, 30240X1, 30240X2, 30240X3, 30240X4, 30240Y0, 30240Y1, 30240Y2, 30240Y3, 30240Y4, 30243AZ, 30243C0, 30243G0, 30243G1, 30243G2, 30243G3, 30243G4, 30243U2, 30243U3, 30243U4, 30243X0, 30243X1, 30243X2, 30243X3, 30243X4, 30243Y0, 30243Y1, 30243Y2, 30243Y3, 30243Y4, 30250G0, 30250G1, 30250X0, 30250X1, 30250Y0, 30250Y1, 30253G0, 30253G1, 30253X0, 30253X1, 30253Y0, 30253Y1, 30260G0, 30260G1, 30260X0, 30260X1, 30260Y0, 30260Y1, 30263G0, 30263G1, 30263X0, 30263X1, 30263Y0, 30263Y1, 3E030U0, 3E030U1, 3E033U0, 3E033U1, 3E0J3U0, 3E0J3U1, 3E0J7U0, 3E0J7U1, 3E0J8U0, 3E0J8U1

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
    • 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, 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
    • 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, B02.30- 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, 216
    • 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, 90686, 90687, 90688, 90689, 90756
    • CVX: 88,140, 141, 150, 153, 155, 158, 161, 171, 186
    • 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