Immunizations: Adult – Exploratory Measure Tip Sheet

This is an exploratory measure; there is no payment for 2022 and 2023. For additional information, refer to the CBI Technical Specifications.

• Members enrolled in hospice
• Members with active chemotherapy during the measurement period.
• Members with a bone marrow transplant during the measurement period.
• Members with a history of immunocompromising conditions, cochlear implants, anatomic or functional asplenia, sickle cell anemia and HbS disease or cerebrospinal fluid leaks.

Members meet the measure requirements when they have received the specified number of doses listed for each of the following vaccines:

Influenza Vaccine
Members 19 years and older who received an influenza vaccine on or between July 1 of the year prior to the measurement period and June 30 of the measurement period.

• Acceptable CPT codes: 90630, 90653, 90654, ,90662, 90673, 90674, 90682, 90686, 90688, 90689, 90694, 90756.

Tdap Vaccine
Members 19 and older who received at least one Td or Tdap vaccine in the prior nine years or during the measurement period-June 30 of the measurement year.

• Acceptable CPT codes: 90714, 90715, 90718.
  • Acceptable SNOMED codes: 428291000124105 (Anaphylaxis due to Diphtheria, Tetanus or Pertussis Vaccine); 192710009, 192711008, 192712001 (Encephalitis due to Diphtheria, Tetanus or Pertussis Vaccine).

Zoster Vaccine
Members 50 years and older who received at least one dose of herpes zoster live vaccine or two doses of the herpes zoster recombinant vaccine (at least 28 days apart) any time before the end of the measurement year.

• Acceptable CPT codes: 90736, 90750.

Data for this measure will be collected using claims, immunization registries (CAIR/RIDE) and provider data submissions via the Data Submission Tool (DST) on the Provider Portal. To find gaps in data:

• Run a report from your Electronic Health Record (EHR) system; or .
• Manually compile patient data (Example: Download monthly adult immunizations quality report or your Care-Based Incentives Measure Details report on the Provider Portal and compare to EHR/paper charts).

This measure allows providers to submit immunization codes from the clinic EHR system or paper records to the Alliance by the DST contractual deadline. To submit, you may upload data files to the DST on the Provider Portal. To submit, you may upload data files to the DST on the Provider Portal. To be accepted, data must be submitted as a CSV file. Step-by-step instructions are available in the Data Submission Tool Guide on the Provider Portal.

• Implement standing orders for vaccines. See the Immunization Action Coalition’s Using Standing Orders for Administering Vaccines: What you Should Know for more information.
• Ensure staff has current accounts with your local immunization registry, and staff are trained to enter both administered vaccines and vaccines from health records into the registry.
• Create a team-based immunization program. Learn more information from the American Medical Association (AMA) STEPS Forward module on Adult Vaccinations: Team-Based Immunization.
• Empower staff to chart prep to review the schedule of immunizations and avoid any missed opportunities like providing a vaccine during a sick visit.
• Maintain strong doctor-patient relationships to help with challenging immunization conversations.
• Utilize an immunization checklist to improve your clinic’s vaccine compliance, such as the Immunization Action Coalition (IAC’s) Suggestions to Improve Immunization Services.
• Visit the Alliance immunization resources web page for more information on vaccine best practices.

• Alliance interpreting services are available to network providers:
  • Telephonic interpreting services are available to assist in scheduling members.
  • Face-to-face interpreters can be requested to be at the appointment with the member.

  For information about our Cultural and Linguistic Services Program, please call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].

• Refer patients who have transportation challenges to the Alliance’s Transportation Coordinator at 800-700-3874, ext. 5577. This service is not covered for non-medical locations or for appointments that are not medically necessary.
• The Alliance’s Immunization Resources web page
• CAIR Immunization Registry http://cairweb.org/ for Santa Cruz and Monterey Counties.
• RIDE (Healthy Futures) Immunization Registry http://www.myhealthyfutures.org/ for Merced County.
• California Immunization Coalition.
• A step-by-step guide to improving vaccine uptake in outpatient settings
• Countering antivaccination attitudes
• 2021-22 Influenza Vaccination Talking Points