Measure Description
The percentage of adolescents 13 years of age who had one dose of meningococcal vaccine (serogroups A, C, W, Y), one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine, and have completed the Human Papillomavirus (HPV) vaccine series by their 13th birthday.
Instructions
This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. There is no diagnosis associated with this measure. Performance for this measure is not limited to the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on services provided and the measure-specific denominator coding.
This measure will be calculated with 4 performance rates:
- Patients who had one dose of meningococcal vaccine (serogroups A, C, W, Y), on or between the patient’s 11th and 13th birthdays
- Patients who had one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) on or between the patient’s 10th and 13th birthdays
- Patients who have completed the HPV vaccine series with different dates of service on or between the patient’s 9th and 13th birthdays
- All patients who are compliant for Meningococcal (serogroups A, C, W, Y), Tdap and HPV during the specified timeframes
For accountability reporting in the CMS MIPS program, the rate for Submission Criteria 4 is used for performance.
NOTE: Patient encounters for this measure conducted via telehealth (including but not limited to encounters coded with GQ, GT, 95, POS 02, POS 10) are allowable.
Measure Submission Type:
Measure data may be submitted by individual MIPS eligible clinicians, groups, or third-party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third-party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third-party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.
Denominator (Submission Criteria for all rates)
Adolescents who turn 13 years of age during the measurement period
DENOMINATOR NOTE: The same denominator is used for all rates.
Denominator Criteria (Eligible Cases):
Patients who turn 13 years of age during the measurement period
AND
Patient encounter during the performance period (CPT or HCPCS): 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, G0402
AND NOT
DENOMINATOR EXCLUSION:
Patients who use hospice services any time during the measurement period: G9761
Numerator (Submission Criteria 1)
Adolescents who had one dose of meningococcal vaccine (serogroups A, C, W, Y), on or between the patient’s 11th and 13th birthdays
Numerator Options:
Performance Met: Patient had one dose of meningococcal vaccine (serogroups A, C, W, Y) on or between the patient’s 11th and 13th birthdays (G9414)
OR
Denominator Exception: Patient had anaphylaxis due to the meningococcal vaccine any time on or before the patient’s 13th birthday (M1160)
OR
Performance Not Met: Patient did not have one dose of meningococcal vaccine (serogroups A, C, W, Y), on or between the patient’s 11th and 13th birthdays (G9415)
Numerator (Submission Criteria 2)
Adolescents who had one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) on or between the patient’s 10th and 13th birthdays
Numerator Options:
Performance Met: Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) on or between the patient’s 10th and 13th birthdays (G9416)
OR
Denominator Exception: Patient had anaphylaxis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient’s 13th birthday (M1161)
OR
Denominator Exception: Patient had encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient’s 13th birthday (M1162)
OR
Performance Not Met: Patient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) on or between the patient’s 10th and 13th birthdays (G9417)
Numerator (Submission Criteria 3)
Adolescents who completed the HPV vaccine series on or between the patient’s 9th and 13th birthdays
Numerator Options:
Performance Met: Patient had at least two HPV vaccines (with at least 146 days between the two) OR three HPV vaccines on or between the patient’s 9th and 13th birthdays (G9762)
OR
Denominator Exception: Patient had anaphylaxis due to the HPV vaccine any time on or before the patient’s 13th birthday (M1163)
OR
Performance Not Met: Patient did not have at least two HPV vaccines (with at least 146 days between the two) OR three HPV vaccines on or between the patient’s 9th and 13th birthdays (G9763)
Numerator (Submission Criteria 4)
Adolescents who are numerator compliant for Rates 1, 2 and 3
Rationale
Adolescent immunization rates have historically lagged behind early childhood immunization rates in the United States. In 2000, the American Academy of Pediatrics (AAP) reported that 3 million adolescents failed to receive at least one recommended vaccination. Low immunization rates among adolescents have the potential to cause outbreaks of preventable diseases and to establish reservoirs of disease in adolescents that can affect other populations including infants, the elderly, and individuals with chronic conditions. Immunization recommendations for adolescents have changed in recent years. In addition to assessing for immunizations that may have been missed, there are new vaccines targeted specifically to adolescents.
This measure follows the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) guidelines for immunizations.
Clinical Recommendation Statements
Receiving recommended vaccinations is the best defense against vaccine-preventable diseases. However, as children get older, the protection they received from some of their childhood vaccinations begins to wear off and they need booster shots. Adolescents are also at risk for vaccine-preventable diseases (e.g., meningococcal meningitis) that are not typically vaccinated against as children.
The tetanus, diphtheria toxoids, and acellular pertussis (Tdap) vaccine is given to adolescents as a booster shot to increase the protection they received in childhood vaccinations. Diphtheria, tetanus, and pertussis are serious diseases that can cause life-threatening illnesses. Diphtheria can cause breathing difficulties, heart problems, nerve damage, pneumonia, and even death. Tetanus can cause seizures and severe muscle spasms strong enough to cause bone fractures of the spine, and causes death in 30 to 40 percent of cases. Pertussis can cause severe coughing spells that can interfere with breathing, as well as pneumonia, long-lasting bronchitis, seizures, brain damage, and death.
Meningococcal disease occurs when the protective membranes covering the brain and spinal cord become infected and swell, and can cause serious complications, such as brain damage, hearing loss, or learning disabilities.
Meningococcal disease is caused by the bacterium Neisseria meningitides, or meningococcus, and is the leading cause of bacterial meningitis in the United States (U.S.).
A meningococcal infection can spread quickly, killing an otherwise healthy adolescent in 48 hours. Although not all cases of meningococcal disease progress into meningitis, 15 percent of the cases that do progress result in death.
Each year, many adolescents miss their recommended vaccinations, leaving them needlessly vulnerable to disease, suffering and death.
Vaccine-preventable diseases are expensive for society as a whole, costing more than $10 billion in direct medical costs and indirect societal costs.
In 2012, pertussis outbreaks were reported in a majority of states, with more than 32,000 cases and 16 deaths.
Outbreaks can occur in workplaces, schools, and homes, and can result in physical, economic, and social costs.
Bacterial meningitis remains a major global health threat, with an estimated 500,000 cases reported worldwide each year, accounting for at least 50,000 deaths. According to preliminary data, meningitis was responsible for 606 deaths in the U.S. in 2011.
Vaccines are a safe and effective way to protect adolescents against potentially deadly diseases and help them develop into healthy adults. Vaccines can protect their family and their community as well.