Adult Immunization Status (AIS‑E) 2025

HEDIS^® (Healthcare Effectiveness Data Information Set) is a widely used set of performance measures developed and maintained by NCQA. These are used to drive improvement efforts surrounding best practices.

The HEDIS quality measures reported using the Electronic Clinical Data Systems (ECDS) inspire innovative use of electronic clinical data to document high‑quality patient care that demonstrates commitment to evidence‑based practices. Organizations that report HEDIS using ECDS encourage the electronic exchange of the information needed to provide high‑quality services, ensuring that the information reaches the right people at the right time.

HEDIS measure

This measure looks at the percentage of patients 19 years of age and older who are up to date on recommended routine vaccines for influenza, tetanus, and diphtheria (Td) or tetanus, diphtheria, and acellular pertussis (Tdap), zoster, pneumococcal, and hepatitis B during the measurement year.

Numerator 1 — Immunization status: influenza

Patients 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;

or

Patients with anaphylaxis due to the influenza vaccine any time before or during the measurement period

Numerator 2 — Immunization status: Td/Tdap

Patients who received at least one Td vaccine or one Tdap vaccine (CVX code 115) between nine years prior to the start of the measurement period and the end of the measurement period;

or

Patients with a history of at least one of the following contraindications any time before or during the measurement period:

• Anaphylaxis due to the diphtheria, tetanus, or pertussis vaccine
• Encephalitis due to the diphtheria, tetanus, or pertussis vaccine

Numerator 3 — Immunization status: zoster

Patients who received two doses of the herpes zoster recombinant vaccine (CVX code 187) at least 28 days apart, on October 1, 2017, through the end of the measurement period;

or

Patients with anaphylaxis due to the herpes zoster vaccine any time before or during the measurement period

Numerator 4 — Immunization status: pneumococcal

Patients who received at least one dose of an adult pneumococcal vaccine on or after their 19th birthday, before or during the measurement period;

or

Patients with anaphylaxis due to the pneumococcal vaccine any time before or during the measurement period

Numerator 5 — Immunization status: hepatitis B

Patients who received at least three doses of the childhood hepatitis B vaccine with different dates of service on or before their 19th birthday:

• One of the three vaccinations can be a newborn hepatitis B vaccination (ICD‑10-PCS code 3E0234Z) during the eight‑day period that begins on the date of birth and ends 7 days after the date of birth. For example, if the member’s date of birth is December 1, the newborn hepatitis B vaccination must be on or between December 1 and December 8.

Patients who received a hepatitis B vaccine series on or after their 19th birthday, before or during the measurement period, including either of the following:

• At least two doses of the recommended two‑dose adult hepatitis B vaccine (CVX code 189) administered at least 28 days apart;

or

• At least three doses of any other recommended adult hepatitis B vaccine administered on different days of service

Patients who had a hepatitis B surface antigen, hepatitis B surface antibody, or total antibody to hepatitis B core antigen test, with a positive result any time before or during the measurement period. Any of the following meet criteria:

• A test with a result greater than 10 mIU/mL
• A test with a finding of immunity (Hepatitis B Immunity Finding Value Set)

Patients with a history of hepatitis B illness any time before or during the measurement period. Do not include laboratory claims (POS 81).

Patients with anaphylaxis due to the hepatitis B vaccine (SNOMED CT code 428321000124101) any time before or during the measurement period

Denominator

Members 19 years and older at the start of the measurement period who also meet the criteria for participation

Exclusions:

• Patients who use hospice services or elect to use a hospice benefit any time during the measurement year
• Patients who die any time during the measurement year

Closing the gap

Document the required age vaccines were received according to the time interval specified in the measure:

• Adult influenza vaccine procedure:
• CPT^®: 90630, 90653, 90654, 90656, 90658, 90661, 90662, 90673, 90674, 90882, 90686, 90688, 90689, 90694, 90756
• Adult pneumococcal vaccine procedure:
• CPT: 90670, 90671, 90677, 90732
• Influenza virus LAIV vaccine procedure:
• CPT: 90660, 90672
• Td vaccine procedure:
• CPT: 90714
• Tdap vaccine procedure:
• CPT: 90715
• Herpes zoster live vaccine procedure:
• CPT: 90736
• Herpes zoster recombinant vaccine procedure:
• CPT: 90750

Best practices:

• Schedule appointments to coincide with required timeframes for immunization administration.
• During visits, talk about the importance of being immunized.
• Ensure that members’ medical records include immunization history from all sources.
• Contact your health plan representative to establish an electronic data transfer with the plan if your organization does not already have one.
• Make full use of CPT II codes to submit care quality findings. Many HEDIS gaps could be closed via claims if CPT II codes were fully used.

Let’s work together

Measure is closed via:

• Claims
• CCDA
• SFTP/flat files
• Cotiviti

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