Products & Programs Federal Employee Program (FEP)CommercialMay 1, 2024

HEDIS tips: Adult Immunization Status (AIS-E)

HEDIS® is a widely used set of performance measures developed and maintained by NCQA. These are used to drive improvement efforts surrounding best practices.

What vaccines are included in the HEDIS Adult Immunization Status (AIS-E) measure?

Influenza: The percentage of members 19 years of age and older who are up to date on recommended routine vaccines for influenza.

Td/Tdap: The percentage of members 19 years of age and older who are up to date on recommended routine vaccines for tetanus and diphtheria (Td) or tetanus, diphtheria, and acellular pertussis (Tdap).

Zoster: The percentage of members 50 years of age and older who are up to date on recommended routine vaccines for zoster.

Pneumococcal: The percentage of members 66 years of age and older who are up to date on recommended routine vaccines for pneumococcal.

Using correct codes can help your practice improve HEDIS AIS-E results.

Using the correct code to capture the vaccine given, or identifying anaphylaxis code to reflect the contraindications, can help your practice with performance rates.

Adult immunization

Immunization description

CPT® codes

HCPCS

CVX

Influenza immunization

90630, 90653, 90654, 90655, 90656, 90657, 90658, 90660*, 90661, 90662, 90672*, 90673, 90674, 90682, 90685, 90686, 90687, 90688, 90689, 90694, 90756

G0008

88, 135, 140, 141,144, 150, 150, 153, 155, 158, 166, 168, 168, 171, 185, 186, 197, 205

Td/Tdap

90714, 90715

09, 113, 115, 138, 139

Zoster immunization

90736, 90750

121, 187

Pneumococcal immunization

90670, 90671, 90677, 90732

G0009

33, 109, 133, 152, 215, 216

* Influenza live virus

Sources: 1. NCQA Health Plan Description AND ECDS: Adult Immunization Status, pages 643 to 650.
2. HEDIS MY 2024 Volume 2 Value Set Directory 2023-08-01: tabs Measures to Value Sets and Value Sets to Codes.

Exclusions:

  • Members who use hospice services; or
  • Members who elect to use a hospice benefit any time during the measurement period; or
  • Members who die any time during the measurement period.
  • Members with a history of at least one of the following contraindications any time during the measurement period.

Exclusions codes for anaphylaxis

Immunization description

SNOMED CT

edition USA codes

Description

Influenza immunization

  • 47136000124100

  • Anaphylaxis due to the influenza vaccine any time before or during the measurement period

Td/Tdap

  • 428281000124107

  • 428291000124105

  • 192710009

  • 192711008

  • 192712001

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

  • Anaphylaxis due to diphtheria, tetanus, or pertussis vaccine (caused by diphtheria and tetanus)
  • Anaphylaxis due to diphtheria, tetanus, or pertussis vaccine (caused by tetanus, diphtheria and acellular pertussis)
  • Encephalitis due to diphtheria, tetanus, or pertussis vaccine (post tetanus vaccination)
  • Encephalitis due to diphtheria, tetanus, or pertussis vaccine (post diphtheria vaccination)
  • Encephalitis due to diphtheria, tetanus, or pertussis vaccine (post pertussis vaccination)

Zoster immunization

  • 471381000124105

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

Pneumococcal immunization

  • 471141000124102

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

Helpful tips

Immunization information obtained from the medical record:

  • A note indicating the name of the specific antigen and the date of the immunization.
  • A certificate of immunization prepared by an authorized healthcare provider or agency, including the specific dates and types of immunization administered.
  • Document in the medical record of refusal or anaphylaxis reaction to the serum/vaccination.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CM-054689-24-CPN54510

PUBLICATIONS: May 2024 Provider Newsletter