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Johns Hopkins Health Plans

CSI - 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. 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

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.
  • 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.
  • 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 any of the following 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
    • CVX: 109,133, 152
    • 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, 90756, 90685- 90689
    • 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