Product Lines:
EHP, Priority Partners, and USFHP.

Eligible Population:
Pregnant members who deliver at >37 weeks during the measurement year.

Definition:
The percentage of deliveries in the measurement period in which members had received influenza and tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccinations.

The denominator for this measure is based on deliveries, not on members.

Numerator 1—Immunization Status: Influenza

• Deliveries where members received an adult influenza vaccine on or between July 1 of the year prior to the measurement period and the delivery date, or
• Deliveries where members had anaphylaxis due to the influenza vaccine on or before the delivery date.

Numerator 2—Immunization Status: Tdap

• Deliveries where members received at least one Tdap vaccine during the pregnancy (including on the delivery date), or
• Deliveries where members had any of the following:
  • Anaphylaxis due to the diphtheria, tetanus or pertussis vaccine on or before the delivery date.
  • Encephalitis due to the diphtheria, tetanus or pertussis vaccine on or before the delivery date.

Numerator 3—Immunization Status: Combination

• Deliveries that met criteria for both numerator 1 and numerator 2.

New for Measure: Stratification by race and ethnicity.

Continuous Enrollment:

• 28 days prior to the delivery date through the delivery date.

Best Practice and Measure Tips

• Identify members with gap. Offer immunization to members during prenatal visits or when admitted for delivery.
• Use appropriate and accurate codes on claims 
• Centers for Disease Control and Prevention recommend that pregnant member receive the following immunizations:
  • A flu shot during any trimester of their pregnancy to protect themselves and their newborn babies from flu
  • 1 dose of Tdap every pregnancy, preferably during early part of gestational weeks 27–36
  • For patient and provider resources, visit: www.cdc.gov/vaccines/pregnancy

Measure Exclusions

Required Exclusions:

• Deliveries that occurred at less than 37 weeks gestation.
• Deliveries in which members were in hospice or using hospice services any time during the measurement period.

Measure Codes

• Immunizations
  • Adult Influenza:
    • CPT: 90630, 90653, 90654, 90656, 90658, 90661, 90662, 90673, 90674, 90682, 90686, 90688, 90689, 90694, 90756
    • CVX: 88, 135, 140, 141, 144, 150, 153, 155, 158, 166, 168, 171, 185, 186, 197, 205
    • Anaphylaxis due to the influenza vaccine SNOMED: 471361000124100
  • Tdap:
    • CPT: 90715
    • CVX: 115
    • Anaphylaxis Due to Diphtheria, Tetanus or Pertussis Vaccine:
      • SNOMED: 428281000124107, 428291000124105
    • Encephalitis Due to Diphtheria, Tetanus or Pertussis Vaccine
      • SNOMED: 192710009, 192711008, 192712001