Measure Description
Percentage of patients aged 18 years and older seen for a visit during the performance period that are up-to-date on their COVID-19 vaccinations as defined by Centers for Disease Control and Prevention (CDC) recommendations on current vaccination.
Instructions
This measure is to be submitted a minimum of once per performance period for patients aged 18 years and older seen during the performance period. There is no diagnosis associated with this measure. This measure may be submitted by Meritbased Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
NOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, POS 02, or POS 10 modifiers) are allowable. Please note that effective January 1, 2025, while a measure may be denoted as telehealth eligible, specific denominator codes within the encounter may no longer be eligible due to changes outlined in the CY 2024 PFS Final Rule List of Medicare Telehealth Services.
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
All patients aged 18 years and older seen for a visit during the performance period
DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.
Denominator Criteria (Eligible Cases):
Patients aged 18 years and older on date of encounter
AND
Patient encounter during the performance period (CPT or HCPCS): 59400, 59510, 59610, 59618, 78012, 78070, 78075, 78102, 78140, 78185, 78195, 78202, 78215, 78261, 78290, 78300, 78305, 78315, 78320, 78414, 78428, 78456, 78458, 78579, 78580, 78582, 78597, 78601, 78630, 78647, 78699, 78708, 78725, 78740, 78801, 78803, 78806, 78999, 90791, 90792, 90832, 90834, 90837, 90839, 90845, 90945, 90947, 90951, 90952, 90953, 90954, 90955, 90956, 90957, 90958, 90959, 90960, 90961, 90962, 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 92002, 92004, 92012, 92014, 92507, 92508, 92521, 92522, 92523, 92524, 92526, 92537, 92538, 92540, 92541, 92542, 92544, 92545, 92548, 92550, 92557, 92567, 92568, 92570, 92588, 92625, 92626, 96116, 96156, 96158, 96159, 97129, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97802, 97803, 97804, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 98960, 98961, 98962, 98966, 98967, 98968, 98970, 98971, 98972, 99024, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99231, 99232, 99233, 99236, 99242*, 99243*, 99244*, 99245*, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99381*, 99382*, 99383*, 99384*, 99385*, 99386*, 99387*, 99391*, 99392*, 99393*, 99394*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99421, 99422, 99423, 99424, 99429*, 99491, 99495, 99496, 99512*, G0101, G0108, G0270, G0271, G0402, G0438, G0439, G0447, G0473, G9054
AND NOT
DENOMINATOR EXCLUSION:
Patient received hospice services any time during the performance period: M1416
Numerator
Patients that are up to date on their COVID-19 vaccinations as defined by CDC recommendations on current vaccination as of the date of the encounter
Definition:
Up to Date – The CDC definition of up to date can be found at https://www.cdc.gov/covid/vaccines/stay-up-todate.html
Numerator Instruction:
In addition to the CDC webpage included in the up to date definition, a document that catalogs the CDC definition of up to date by date is maintained at https://qpp-cm-prod-content.s3.amazonaws.com/uploads/3087/CDC-COVID19-Vaccination-Recommendations.zip
NUMERATOR NOTE: The definition of up to date vaccination status may change over time. Therefore, MIPS eligible clinicians should refer to the definition of up to date per the CDC at the time of the visit to which the measure is applied.
Denominator Exception(s) are determined at the time of the denominator eligible encounter.
Numerator Options:
Performance Met: Patients who are up to date on their COVID-19 vaccinations as defined by CDC recommendations on current vaccination (M1417)
OR
Denominator Exception: Patients who are not up to date on their COVID-19 vaccinations as defined by CDC recommendations on current vaccination because of a medical contraindication documented by clinician (M1418)
OR
Performance Not Met: Patients who are not up to date on their COVID-19 vaccinations as defined by CDC recommendations on current vaccination (M1419)
Rationale
In March 2022, a report found that receiving 2 or 3 doses of an mRNA COVID-19 vaccine was associated with a 90% reduction in risk for COVID-19 invasive mechanical ventilation or death [1]. As of October 28, 2023, the CDC reported 6,593,929 hospitalizations from COVID-19 and 1,161,602 deaths [2]. In 2022, COVID-19 was the fourth leading cause of death in the United States [3]. However, only 18.3% of adults reported having received an updated 2023-24 COVID-19 vaccine since September 14, 2023 [4]. Widespread vaccination to prevent severe COVID-19 infection will be critically important to stemming the morbidity and mortality caused by this disease.
References
1. Centers for Disease Control & Prevention. (2022, March 25). Effectiveness of mRNA Vaccination in Preventing COVID-19-Associated Invasive Mechanical Ventilation and Death – United States, March 2021 – January 2022. Morbidity and Mortality Weekly Report, 71(12), 459-465. https://www.cdc.gov/mmwr/volumes/71/wr/mm7112e1.htm
2. Centers for Disease Control & Prevention. (2024). COVID Data Tracker. https://covid.cdc.gov/covid-datatracker/#datatracker-home
3. Centers for Disease Control & Prevention. (2023, May 5). Provisional Mortality Data – United States, 2022. Morbidity and Mortality Weekly Report, 72(18), 488-492. https://www.cdc.gov/mmwr/volumes/72/wr/mm7218a3.htm?s_cid=mm7218a3_w%20%5bcdc.gov%5d
4. Centers for Disease Control & Prevention. (2024). Weekly COVID-19 Vaccination Dashboard. https://www.cdc.gov/vaccines/imz-managers/coverage/covidvaxview/interactive/vaccination-dashboard.html
Clinical Recommendation Statements
Since December 2020, there have been 19 Advisory Committee on Immunization Practices (ACIP) recommendations relating to COVID-19 vaccination. On September 12, 2023 the ACIP recommended vaccination with updated COVID-19 vaccines for all persons aged 6 months and older [1]. Updated COVID-19 vaccines are considered the 2023-2024 formula and include Moderna, Pfizer-BioNTech and Novavax. Because this measure uses the CDC’s definition of up to date, please refer to the CDC’s website [2] to confirm the current definition of up to date.
References
1. Centers for Disease Control & Prevention. (2023, October 20). Use of Updated COVID-19 Vaccines 2023-2024 Formula for Persons Aged >= 6 Months: Recommendations of the Advisory Committee on Immunization Practices – United States, September 2023. Morbidity and Mortality Weekly Report, 72(42), 1140-1146. https://www.cdc.gov/mmwr/volumes/72/wr/mm7242e1.htm
2. Centers for Disease Control & Prevention. (2024). COVID-19: Stay Up to Date with COVID-19 Vaccines. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html