Measure Description
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.
Instructions
This measure is to be submitted a minimum of once per performance period for all patients 19 years of age and older on the date of the encounter. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure for patients age 19 years of age and older based on the services provided and the measure-specific denominator coding.
NOTE: Patient encounters for this measure conducted via telehealth (including but not limited to encounters coded with GQ, GT, POS 02, POS 10) 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.
This measure will be calculated with 4 performance rates:
1. Percentage of patients (19 years of age and older on the date of the encounter) 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
2. Percentage of patients (19 years of age and older on the date of the encounter) who received at least 1 tetanus and diphtheria (Td) vaccine or 1 tetanus, diphtheria, and pertussis (Tdap) vaccine between 9 years prior to the encounter and the end of the measurement period
3. Percentage of patients (50 years of age and older on the date of the encounter) who received 2 doses of the herpes zoster recombinant vaccine anytime on or after the patients’ 50th birthday
4. Percentage of patients (66 years of age or older on the date of the encounter) who were administered any pneumococcal conjugate vaccine or polysaccharide vaccine, on or after their 19th birthday and before the end of the measurement period
Submission of the four performance rates is required for this measure. A weighted average, which is the sum of the performance numerator values divided by the sum of performance denominator values, will be used to calculate performance.
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 1)
Patients 19 years of age and older on the date of the encounter with a visit during the measurement 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 1):
Patients age 19 and older on the date of the encounter
AND
Patient encounter during the performance period (CPT): : 90945, 90947, 90957, 90958, 90959, 90960, 90961, 90962, 90965, 90966, 90969, 90970, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, 99512*, G0438, G0439
AND NOT
DENOMINATOR EXCLUSION:
In hospice or using hospice services during the measurement period (HCPCS): M1167
Numerator (Submission Criteria 1)
Patients in Denominator 1 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
NUMERATOR NOTE: Patient reported vaccine receipt, when recorded in the medical record, is acceptable for meeting the numerator.
Numerator Options:
Performance Met: Patient received an influenza vaccine on or between July 1 of the year prior to the measurement period and June 30 of the measurement period (M1168)
OR
Denominator Exception: Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine) (M1169)
OR
Performance Not Met: Patient did not receive an influenza vaccine on or between July 1 of the year prior to the measurement period and June 30 of the measurement period (M1170)
Denominator (Submission Criteria 2)
Patients 19 years of age and older on the date of the encounter with a visit during the measurement 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 2):
Patients age 19 and older on the date of the encounter
AND
Patient encounter during the performance period (CPT): 90945, 90947, 90957, 90958, 90959, 90960, 90961, 90962, 90965, 90966, 90969, 90970, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, 99512*, G0438, G0439
AND NOT
DENOMINATOR EXCLUSION:
In hospice or using hospice services during the measurement period (HCPCS): M1167
Numerator (Submission Criteria 2)
Patients in Denominator 2 who received at least 1 Td vaccine or 1 Tdap vaccine between 9 years prior to the encounter and the end of the measurement period
NUMERATOR NOTE: Patient reported vaccine receipt, when recorded in the medical record, is acceptable for meeting the numerator.
Numerator Options:
Performance Met: Patient received at least one Td vaccine or one Tdap vaccine between nine years prior to the encounter and the end of the measurement period (M1171)
OR
Denominator Exception: Documentation of medical reason(s) for not administering Td or Tdap vaccine (e.g., prior anaphylaxis due to the Td or Tdap vaccine or history of encephalopathy within seven days after a previous dose of a Td-containing vaccine) (M1172)
OR
Performance Not Met: Patient did not receive at least one Td vaccine or one Tdap vaccine between nine years prior to the encounter and the end of the measurement period (M1173)
Denominator (Submission Criteria 3)
Patients 50 years of age and older on the date of the encounter with a visit during the measurement 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 3):
Patients age 50 and older on the date of the encounter
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.
AND
Patient encounter during the performance period (CPT): : 90945, 90947, 90960, 90961, 90962, 90966, 90970, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99386*, 99387*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, 99512*, G0438, G0439
AND NOT
DENOMINATOR EXCLUSIONS:
In hospice or using hospice services during the measurement period (HCPCS): M1167
Numerator (Submission Criteria 3)
Patients in Denominator 3 who received 2 doses of the herpes zoster recombinant vaccine anytime on or after the patients’ 50th birthday
NUMERATOR NOTE: Patient reported vaccine receipt, when recorded in the medical record, is acceptable for meeting the numerator
Numerator Options:
Performance Met: Patient received at least two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient’s 50th birthday before or during the measurement period (M1174)
OR
Denominator Exception: Documentation of medical reason(s) for not administering zoster vaccine (e.g., prior anaphylaxis due to the zoster vaccine) (M1175)
OR
Denominator Exception: Documentation that administration of second recombinant zoster vaccine could not occur during the performance period due to the recommended 2-6 month interval between doses (i.e., first dose received after October 31) (M1238)
OR
Performance Not Met: Patient did not receive two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient’s 50th birthday before or during the measurement period (M1176)
Denominator (Submission Criteria 4)
Patients 66 years of age or older on the date of the encounter with a visit during the measurement 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 4):
Patients age 66 and older on the date of the encounter
AND
Patient encounter during the performance period (CPT): 90945, 90947, 90960, 90961, 90962, 90966, 90970, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99387*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, 99512*, G0438, G0439
AND NOT
DENOMINATOR EXCLUSION:
In hospice or using hospice services during the measurement period (HCPCS): M1167
Numerator (Submission Criteria 4)
Patients in Denominator 4 who were administered any pneumococcal conjugate vaccine or polysaccharide vaccine, on or after their 19th birthday and before the end of the measurement period
NUMERATOR NOTE: The measure provides credit for adults 66 years of age and older who have received any pneumococcal vaccine on or after the patient’s 19th birthday.
Patient reported vaccine receipt, when recorded in the medical record, is acceptable for meeting the numerator.
Numerator Options:
Performance Met: Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period (M1177)
OR
Denominator Exception: Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., prior anaphylaxis due to the pneumococcal vaccine) (M1178)
OR
Performance Not Met: Patient did not receive any pneumococcal conjugate or polysaccharide vaccine, on or after their 19th birthday and before or during measurement period (M1179)
Denominator (Submission Criteria 5)
Patients 19 years of age or older on the date of the encounter with a visit during the measurement 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 5):
Patients age 19 and older on the date of the encounter
AND
Patient encounter during the performance period (CPT): 90945, 90947, 90957, 90958, 90959, 90960, 90961, 90962, 90965, 90966, 90969, 90970, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, 99512*, G0438, G0439
AND NOT
DENOMINATOR EXCLUSION:
In hospice or using hospice services during the measurement period (HCPCS): M1167
Numerator (Submission Criteria 5)
Patients in Denominator 5 who were administered a hepatitis B vaccine series.
Numerator Instructions:
In order to meet criteria for this numerator, patients must have one of the following: 1) at least three doses of the childhood hepatitis B vaccine with different dates of service on or before their 19th birthday; 2) at least two doses of the recommended two-dose adult hepatitis B vaccine administered at least 28 days apart; and 3) at least three doses of any other recommended adult hepatitis B vaccine administered on different dates of service.
NUMERATOR NOTE: Patient reported vaccine receipt, when recorded in the medical record, is acceptable for meeting the numerator.
Numerator Options:
Performance Met: Patient received recommended doses of hepatitis B vaccination based on age (M1468)
OR
Denominator Exception: Patient has a history of hepatitis B illness or received 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 (M1469)
OR
Denominator Exception: Documentation of medical reason(s) for not administering hepatitis B vaccine (e.g., prior anaphylaxis due to the hepatitis B vaccine) (M1470)
OR
Denominator Exception: Documentation that patient is a Medicare Fee-For-Service beneficiary and without additional supplementary insurance coverage for whom Hep B vaccination is not reimbursable under current Medicare Part B coverage rules (M1471)
OR
Performance Not Met: Patient did not receive recommended doses of hepatitis B vaccination based on age (M1472)
Rationale
The Advisory Committee on Immunization Practices (ACIP) recommends influenza and Td/Tdap vaccination for all adults 19 years of age and older; herpes zoster vaccination for all adults 50 years and older; and pneumococcal vaccination for all adults 65 and older and for those 18–64 with certain underlying conditions; and hepatitis B for adults 19–59 years of age (Wodi, et al. 2025). These vaccines have been included in long-standing recommendations to prevent serious disease, but vaccination coverage remains low, leaving many adults unprotected against vaccine-preventable diseases (Hung, et al., 2024).
Estimates of national vaccination coverage are available through the National Health Interview Survey (NHIS), in which a sample of adults self-report receipt of vaccines. In 2022, the survey found that only 22.8% of adults 19 and older were up to date on all recommended age-appropriate vaccines (Hung, et al., 2024). Only 49.4% of adults aged 19 and older received the influenza vaccine during the 2021–2022 flu season. Herpes zoster vaccine receipt for any type of herpes zoster vaccination was reported among only 36% of adults aged 50 and older. When looking specifically at receipt of the recombinant zoster vaccine, only 25.6% of adults 50 and older reported receiving 1 or more doses of the vaccine. Receipt of the pneumococcal vaccine among adults aged 65 and older was 64% in 2022 (Hung, et al., 2024). NHIS data from 2021 found that of adults 19 years and older, 34% reported receiving the hepatitis B vaccination (Hung, et al., 2023) NHIS data from 2019 found that of adult 19 years and older, 62.9% reported having received any tetanus toxoidcontaining vaccination in the past 10 years, and 30.1% reported receiving the Tdap vaccine in the past 10 years (Jatlaoui, et al., 2022). Racial disparities in coverage exist across all five vaccines, with White adults reporting higher rates of vaccine receipt when compared to Black, Hispanic and Asian adults (Hung, et al., 2023; Jatlaoui, et al., 2022).
There are evidence-based practices for improving adult vaccination coverage. Health care providers should routinely assess patients’ vaccination history; strongly recommend appropriate vaccines; offer needed vaccines to adults or refer patients to a provider who can administer the vaccine; and document vaccinations received by their patients in an immunization information system (Lu, et al., 2021). In addition, providing easy access and convenience for adult vaccination in and outside the health care setting is important for increasing equitable adult vaccine uptake (KFF, 2020). Sharing immunization related information between providers, health systems, public health agencies and patients is required to increase vaccination coverage and ensure high-quality data to inform clinical and public health interventions (Scharf, et al., 2021). Leveraging health information technology, such as immunization information systems, is important for targeting and monitoring immunization program activities and providing clinical decision support at the point of care (Scharf, et al., 2021).
References:
Murthy N, Wodi AP, Bernstein H, McNally V, Cineas S, Ault K. 2023. “Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2023.” MMWR Morb Mortal Wkly Rep 2023;72:141-133. DOI: http://dx.doi.org/10.15585/mmwr.mm7206a2
Lu, P., M. Hung, A. Srivastav, et al. 2021. “Surveillance of Vaccination Coverage among Adult Populations—United States, 2018.” MMWR Surveill Summ 2021. 70(No. SS-3):1–26. DOI: http://dx.doi.org/10.15585/mmwr.ss7003a1
Hung, M.C., et al. 2023. “Vaccination Coverage among Adults in the United States, National Health Interview Survey, 2021.” Last updated July 19. https://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/pubsresources/vaccination-coverage-adults-2021.html#:~:text=40.2%25)%20adults.- ,Among%20adults%20aged%2019%E2%80%9349%20years%2C%20White%20adults%20had%20higher,than%20 Asian%20(47.0%25)
Jatlaoui T., Hung, M. et al. 2022 “Vaccination Coverage among Adults in the United States, National Health Interview Survey, 2019-2020.” Last Updated February 17, 2022. https://www.cdc.gov/vaccines/imzmanagers/coverage/adultvaxview/pubs-resources/vaccination-coverage-adults-2019-2020.html
Williams, W.W., Lu, P., O’Halloran, A. et al. 2017. “Surveillance of Vaccination Coverage among Adult Populations—United States, 2015.” MMWR Surveill Summ 2017. 66 (No. SS-11):1-28. DOI: http://dx.doi.org/10.15585/mmwr.ss6611a1.
Ventola, C.L. 2016. “Immunization in the United States: Recommendations, Barriers, and Measures to Improve Compliance: Part 2: Adult Vaccinations.” Pharmacy and Therapeutics. 41(8), 492–506.
America’s Health Insurance Plans. 2015. “Stakeholder Roundtable: Improving Adult Immunization Rates.” Retrieved from https://www.ahip.org/documents/Vaccine_Report_8.26.15-1.pdf
Clinical Recommendation Statements
The Advisory Committee on Immunization Practices recommends annual influenza vaccination; and tetanus, diphtheria and acellular pertussis (Tdap) and/or tetanus and diphtheria (Td) vaccine; herpes zoster vaccine; pneumococcal vaccine; and hepatitis B vaccine for adults at various ages.
Reference:
Wodi, A.P., Issa, A.N., Moser, C.A., Cineas, S. 2025. “Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2025.” MMWR Morb Mortal Wkly Rep 2025;74:30–33. DOI: http://dx.doi.org/10.15585/mmwr.mm7402a3.
Hung, M.-C., Srivastav, A., Lu, P.-j., Black, C.L., Lindley, M.C., Singleton, J.A. 2024. “Vaccination Coverage among Adults in the United States, National Health Interview Survey, 2022.” Updated October 4. https://www.cdc.gov/adultvaxview/publications-resources/adult-vaccinati…;
Hung, M.-C., Srivastav, A., Lu, P.-j., Black, C.L., Jatlaoui, T.C., Lindley, M.C., Singleton, J.A. 2023. “Vaccination Coverage among Adults in the United States, National Health Interview Survey, 2021.” Updated July 19. https://www.cdc.gov/adultvaxview/publications-resources/vaccination-cov…;
Jatlaoui T., Hung, M. et al. 2022 “Vaccination Coverage among Adults in the United States, National Health Interview Survey, 2019-2020.” Last Updated February 17, 2022. https://www.cdc.gov/vaccines/imzmanagers/coverage/adultvaxview/pubs-res…;
Lu, P., M. Hung, A. Srivastav, et al. 2021. “Surveillance of Vaccination Coverage among Adult Populations—United States, 2018.” MMWR Surveill Summ 2021. 70(No. SS-3):1–26. DOI: http://dx.doi.org/10.15585/mmwr.ss7003a1
Kaiser Family Foundation (KFF). 2020. Addressing Racial Equity in Vaccine Distribution. https://www.kff.org/racialequity-and-health-policy/issue-brief/addressi… (accessed January 31, 2024).
Scharf, L.G., R. Coyle, K. Adeniyi, J. Fath, L. Harris, S. Myerburg, M. Kurilo, & E. Abbott. 2021. “Current Challenges and Future Possibilities for immunization Information Systems.” Academic Pediatrics 21(4), S57–64.