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COVID-19

Childhood Immunization Status (CIS)

HEDIS Measure

Childhood Immunization Status (CIS)

Line of business: Commercial Medicaid

Data Collection Method: Administrative and Hybrid

Measure Description

The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and three combination rates.

Numerator Compliance

DTaP, IPV, HiB, pneumococcal conjugate, rotavirus and influenza

Evidence of the antigen or combination vaccine. For combination vaccinations that require more than one antigen (i.e., DTaP and MMR), there must be evidence of all the antigens.

DTaP: At least four DTaP vaccinations with different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.

IPV: At least three IPV vaccinations with different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.

MMR: Any of the following meet criteria:
At least one MMR vaccination on or between the child’s first and second birthdays.
At least one measles and rubella vaccination and one of the following:

  • At least one mumps vaccination on or between the child’s first and second birthdays.
  • History of mumps illness (Mumps Value Set) any time on or before the child’s second birthday.

Any combination of codes below that indicates evidence of all three antigens (on the same or different date of service).

  • At least one measles vaccination administered on or between the child’s first and second birthdays
  • History of measles illness anytime on or before the child’s second birthday.
  • At least one mumps vaccination administered on or between the child’s first and second birthdays OR history of mumps illness anytime on or before the child’s second birthday.
  • At least one rubella vaccination administered on or between the child’s first and second birthdays OR History of rubella illness anytime on or before the child’s second birthday.

HiB: At least three HiB vaccinations with different dates of service on or before the child’s second birthday. Do not count a vaccine administered prior to 42 days after birth.

Hepatitis B: Any of the following on or before the child’s second birthday meet criteria:

  • At least three hepatitis B vaccinations with different dates of service.
    • One of the three vaccinations can be a newborn hepatitis B vaccination during the eight-day period that begins on the date of birth and ends seven days after the date of birth.
  • History of hepatitis illness

VZV: Either of the following on or between the child’s first and second birthdays meet criteria:

  • At least one VZV vaccination with a date of service on or between the child's first and second birthdays.
  • History of varicella zoster on or before the child’s second birthday.

Pneumococcal conjugate: At least four pneumococcal conjugate vaccinations with different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.

Hepatitis A: Either of the following on or between the child’s first and second birthdays meet criteria:

  • At least one hepatitis A vaccination with a date of service on or between the child’s first and second birthdays.
  • History of hepatitis A illness on or before the child’s second birthday.

Rotavirus: Any of the following on or before the child’s second birthday meet criteria. Do not count a vaccination administered prior to 42 days after birth.

  • At least two doses of the two-dose rotavirus vaccine on different dates of service.
  • At least three doses of the three-dose rotavirus vaccine on different dates of service.
  • At least one dose of the two-dose rotavirus vaccine and at least two doses of the three-dose rotavirus vaccine all on different dates of service.

NOTE: If the medical record does not indicate 2 or 3 dose, it is assumed to be a 3 dose series.

Influenza: At least two influenza vaccinations with different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 6 months (180 days) after birth.

NOTE: LAIV vaccination will only be counted if administered on the child’s second birthday.

Best Practices

  • Schedule appointments to coincide with required timeframes for immunization administration
  • Use your electronic medical record (EMR) system to set reminder flags
  • During visits, talk to parents about the importance of having their children immunized
  • Ensure the member’s medical record includes immunization history from all sources (NOTE: “Child is up to date with all immunizations” does not meet compliance)
  • Update the New Jersey Immunization Information System registry
  • Reference the CDC Immunization Vaccine Schedule: cdc.gov/vaccines/schedules

Quality Value Set Directory Coding Tips

DTaP

DTaP Immunization

CVX

  • 20
  • 50
  • 106
  • 107
  • 110
  • 120
  • 146

DTaP Vaccine Procedure

CPT

  • 90697
  • 90698
  • 90700
  • 90723

SNOMED CT US Edition

  • 170395004
  • 170396003
  • 170397007
  • 170399005
  • 170400003
  • 170401004
  • 170402006
  • 310306005
  • 310307001
  • 310308006
  • 312870000
  • 313383003
  • 390846000
  • 390865008
  • 399014008
  • 412755006
  • 412756007
  • 412757003
  • 412762002
  • 412763007
  • 412764001
  • 414001002
  • 414259000
  • 414620004
  • 415507003
  • 415712004
  • 770608009
  • 770616000
  • 770617009
  • 770618004
  • 787436003
  • 787438002
  • 866158005
  • 866159002
  • 866226006
  • 428251000124104
  • 571571000119105
  • 572561000119108
  • 16290681000119103
  • 16298561000119108

HIB B

Haemophilus Influenza Type B (HiB) Immunization

CVX

  • 17
  • 46
  • 47
  • 48
  • 49
  • 50
  • 51
  • 120
  • 146
  • 148

Haemophilus Influenza Type B (HiB) Vaccine Procedure

CPT

  • 90644
  • 90647
  • 90648
  • 90697
  • 90698
  • 90748

SNOMED CT US Edition

  • 127787002
  • 170343007
  • 170344001
  • 170345000
  • 170346004
  • 310306005
  • 310307001
  • 310308006
  • 312869001
  • 312870000
  • 414001002
  • 414259000
  • 415507003
  • 415712004
  • 770608009
  • 770616000
  • 770617009
  • 770618004
  • 786846001
  • 787436003
  • 787438002
  • 16292241000119109

HEP A

Hepatitis A (Illness)

ICD10CM

  • B15.0
  • B15.9

SNOMED CT US Edition

  • 16060001
  • 18917003
  • 25102003
  • 40468003
  • 43634002
  • 79031007
  • 111879004
  • 165997004
  • 206373002
  • 278971009
  • 310875001
  • 424758008
  • 428030001
  • 105801000119103

Hepatitis A Immunization

CVX

  • 31
  • 83
  • 85

Hepatitis A Vaccine Procedure

CPT

  • 90633

SNOMED CT US Edition

  • 170378007
  • 170379004
  • 170380001
  • 170381002
  • 170434002
  • 170435001
  • 170436000
  • 170437009
  • 243789007
  • 312868009
  • 313188000
  • 313189008
  • 314177003
  • 314178008
  • 314179000
  • 394691002
  • 412742005
  • 412743000
  • 871752004
  • 871753009
  • 871754003
  • 571511000119102

HEP B

Hepatitis B (Illness)

ICD10CM

  • B16.0
  • B16.1
  • B16.2
  • B16.9
  • B17.0
  • B18.0
  • B18.1
  • B19.10
  • B19.11

SNOMED CT US Edition

  • 1116000
  • 13265006
  • 26206000
  • 38662009
  • 50167007
  • 53425008
  • 60498001
  • 61977001
  • 66071002
  • 76795007
  • 111891008
  • 165806002
  • 186624004
  • 186626002
  • 186639003
  • 235864009
  • 235865005
  • 235869004
  • 235871004
  • 271511000
  • 313234004
  • 406117000
  • 424099008
  • 424340000
  • 442134007
  • 442374005
  • 446698005
  • 838380002
  • 153091000119109

Hepatitis B Immunization

CVX

  • 08
  • 44
  • 45
  • 51
  • 110
  • 146

Hepatitis B Vaccine Procedure

CPT

  • 90697
  • 90723
  • 90740
  • 90744
  • 90747
  • 90748

HCPCS

  • G0010

SNOMED CT US Edition

  • 16584000
  • 170370000
  • 170371001
  • 170372008
  • 170373003
  • 170434002
  • 170435001
  • 170436000
  • 170437009
  • 312868009
  • 396456003
  • 770608009
  • 770616000
  • 770617009
  • 770618004
  • 786846001
  • 787438002
  • 572561000119108

Newborn Hepatitis B Vaccine Administered

ICD10PCS

  • 3E0234Z
  • 99.55

POLIO

Inactivated Polio Vaccine (IPV) Immunization

CVX

  • 10
  • 89
  • 110
  • 120
  • 146

Inactivated Polio Vaccine (IPV) Procedure

CPT

  • 90697
  • 90698
  • 90713
  • 90723

SNOMED CT US Edition

  • 310306005
  • 310307001
  • 310308006
  • 312869001
  • 312870000
  • 313383003
  • 390865008
  • 396456003
  • 412762002
  • 412763007
  • 412764001
  • 414001002
  • 414259000
  • 414619005
  • 414620004
  • 415507003
  • 415712004
  • 416144004
  • 416591003
  • 417211006
  • 417384007
  • 417615007
  • 786846001
  • 866186002
  • 866227002
  • 868266002
  • 868267006
  • 868268001
  • 868273007
  • 868274001
  • 868276004
  • 868277008
  • 870670004
  • 572561000119108
  • 16290681000119103

FLU

Influenza Immunization

CVX

  • 88
  • 140
  • 141
  • 150
  • 153
  • 155
  • 158
  • 161

Influenza Vaccine Procedure

CPT

  • 90655
  • 90657
  • 90661
  • 90673
  • 90685
  • 90686
  • 90687
  • 90688
  • 90689

HCPCS

  • G0008

SNOMED CT US Edition

  • 86198006
  • 786847005
  • 787016008

Influenza Virus LAIV Immunization

CVX

  • 111
  • 149

Influenza Virus LAIV Vaccine Procedure

CPT

  • 90660
  • 90672

MMR

Measles, Mumps and Rubella (MMR) Immunization

CVX

  • 03
  • 94

Measles, Mumps and Rubella (MMR) Vaccine Procedure

CPT

  • 90707
  • 90710

SNOMED CT US Edition

  • 38598009
  • 170433008
  • 432636005
  • 433733003
  • 150971000119104
  • 571591000119106
  • 572511000119105

Mumps (Illness)

ICD10CM

  • B26.0
  • B26.1
  • B26.2
  • B26.3
  • B26.81
  • B26.82
  • B26.83
  • B26.84
  • B26.85
  • B26.89
  • B26.9

SNOMED CT US Edition

  • 10665004
  • 17121006
  • 31524007
  • 31646008
  • 36989005
  • 40099009
  • 44201003
  • 63462008
  • 72071001
  • 74717002
  • 75548002
  • 78580004
  • 89231008
  • 89764009
  • 111870000
  • 161420006
  • 235123001
  • 236771002
  • 237443002
  • 240526004
  • 240527008
  • 240529006
  • 371112003
  • 105821000119107

Measles (Illness)

ICD10CM

  • B05.0
  • B05.1
  • B05.2
  • B05.3
  • B05.4
  • B05.81
  • B05.89
  • B05.9

SNOMED CT US Edition

  • 14189004
  • 28463004
  • 38921001
  • 60013002
  • 74918002
  • 111873003
  • 161419000
  • 186561002
  • 186562009
  • 195900001
  • 240483006
  • 359686005
  • 371111005
  • 406592004
  • 417145006
  • 424306000
  • 105841000119101
  • 240484000

Rubella (Illness)

ICD10CM

  • B06.00
  • B06.01
  • B06.02
  • B06.09
  • B06.81
  • B06.82
  • B06.89
  • B06.9

SNOMED CT US Edition

  • 10082001
  • 13225007
  • 19431000
  • 36653000
  • 51490003
  • 64190005
  • 79303006
  • 84611003
  • 111867004
  • 128191000
  • 161421005
  • 165792000
  • 186567003
  • 186570004
  • 192689006
  • 231985001
  • 232312000
  • 240485004
  • 253227001
  • 406112006
  • 406113001
  • 1092361000119109
  • 10759761000119100

PCV

Pneumococcal Conjugate Immunization

CVX

  • 109
  • 133
  • 152

Pneumococcal Conjugate Vaccine Procedure

CPT

  • 90670

HCPCS

  • G0009

SNOMED CT US Edition

  • 434751000124102

ROTAVIRUS

Rotavirus (2 Dose Schedule) Immunization

CVX

  • 119

Rotavirus Vaccine (2 Dose Schedule) Procedure

CPT

  • 90681

Rotavirus (3 Dose Schedule) Immunization

CVX

  • 116
  • 122

SNOMED CT US Edition

  • 434741000124104

Rotavirus Vaccine (3 Dose Schedule) Procedure

CPT

  • 90680

SNOMED CT US Edition

  • 434731000124109

VARICELLA

Varicella Zoster (VZV) Immunization

CVX

  • 21
  • 94

Varicella Zoster (VZV) Vaccine Procedure

CPT

  • 90710
  • 90716

SNOMED CT US Edition

  • 425897001
  • 428502009
  • 473164004
  • 571611000119101

Varicella Zoster (Illness)

ICD10CM

  • B01.0
  • B01.11
  • B01.12
  • B01.2
  • B01.81
  • B01.89
  • B01.9
  • B02.0
  • B02.1
  • B02.21
  • B02.22
  • B02.23
  • B02.24
  • B02.29
  • B02.30
  • B02.31
  • B02.32
  • B02.33
  • B02.34
  • B02.39
  • B02.7
  • B02.8
  • B02.9

SNOMED CT US Edition

  • 4740000
  • 10698009
  • 21954000
  • 23737006
  • 24059009
  • 36292003
  • 38907003
  • 42448002
  • 49183009
  • 55560002
  • 87513003
  • 111859007
  • 111861003
  • 161423008
  • 186524006
  • 186525007
  • 195911009
  • 230176008
  • 230198004
  • 230262004
  • 230536009
  • 232400003
  • 235059009
  • 240468001
  • 240470005
  • 240471009
  • 240472002
  • 240473007
  • 240474001
  • 309465005
  • 371113008
  • 397573005
  • 400020001
  • 402897003
  • 402898008
  • 402899000
  • 410500004
  • 410509003
  • 421029004
  • 422127002
  • 422446008
  • 422471006
  • 422666006
  • 423333008
  • 423628002
  • 424353002
  • 424435009
  • 424801004
  • 424941009
  • 425356002
  • 426570007
  • 428633000
  • 713250002
  • 713733003
  • 713964006
  • 715223009
  • 723109003
  • 838357005
  • 12551000132107
  • 12561000132105
  • 12571000132104
  • 98541000119101
  • 331071000119101
  • 681221000119108
  • 1087131000119102
  • 15678761000119105
  • 15678801000119102
  • 15678841000119100
  • 15680201000119106
  • 15680241000119108
  • 15680281000119103
  • 15685081000119102
  • 15685121000119100
  • 15685201000119100
  • 15685281000119108
  • 15936581000119108
  • 15936621000119108
  • 15989271000119107
  • 15989311000119107
  • 15989351000119108
  • 15991711000119108
  • 15991751000119109
  • 15991791000119104
  • 15992351000119104
  • 16000791000119100
  • 16000831000119106