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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
110 0041 Process Yes Community/Population Health Claims

Measure Description

Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization

Instructions

This measure is to be submitted a minimum of once for visits for patients seen between January and March for the 2017-2018 influenza season AND a minimum of once for visits for patients seen between October and December
for the 2018-2019 influenza season. This measure is intended to determine whether or not all patients aged 6 months and older received (either from the submitting eligible clinician or an alternate care provider) the influenza immunization during the flu season. There is no diagnosis associated with this measure. This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding

  • If submitting this measure between January 1, 2018 and March 31, 2018, quality-data code G8482 should be submitted when the influenza immunization is administered to the patient during the months of August, September, October, November, and December of 2017 or January, February, and March of 2018 for the flu season ending March 31, 2018.
  • If submitting this measure between October 1, 2018 and December 31, 2018, quality-data code G8482 should be submitted when the influenza immunization is administered to the patient during the months of August, September, October, November, and December of 2018 for the flu season ending March 31, 2019.
  • Influenza immunizations administered during the month of August or September of a given flu season (either 2017-2018 flu season OR 2018-2019 flu season) can be submitted when a visit occurs during the flu season (October 1 – March 31). In these cases, G8482 should be submitted.

NOTE: No notes for this Quality ID

Measure Submission

The listed denominator criteria is used to identify the intended patient population. The numerator quality-data codes included in this specification are used to submit the quality actions allowed by the measure. All measure-specific coding should be submitted on the claim(s) representing the eligible encounter.

Numerator

Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization

Numerator Instructions:

The numerator for this measure can be met by submitting either administration of an influenza vaccination or that the patient reported previous receipt of the current season’s influenza immunization. If the performance of the numerator is not met, an eligible clinician can submit a valid denominator exception for having not administered an influenza vaccination. For eligible clinicians submitting a denominator exception for this measure, there should be a clear rationale and documented reason for not administering an influenza immunization if the patient did not indicate previous receipt, which could include a medical reason (e.g., patient allergy), patient reason (e.g., patient declined), or system reason (e.g., vaccination not available). The system reason should be indicated only for cases of disruption or shortage of influenza vaccination supply.

As a result of updated CDC/ACIP guidelines which include the interim recommendation that live attenuated influenza vaccine (LAIV) should not be used due to low effectiveness against influenza A(H1N1)pdm09 in the United States during the 2013–14 and 2015–16 seasons, LAIV or intranasal flu vaccine is no longer an option for numerator eligibility.

Definition:
Previous Receipt – Receipt of the current season’s influenza immunization from another provider OR from same provider prior to the visit to which the measure is applied (typically, prior vaccination would include influenza vaccine given since August 1st).

Numerator Quality-Data Coding Options

Denominator Exception: G8483:

Influenza Immunization not Administered for Documented Reasons

Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)

Performance Met: G8482:
Influenza Immunization Administered

Influenza immunization administered or previously received

Performance Not Met: G8484:
Influenza Immunization not Administered, Reason not Given

Influenza immunization was not administered, reason not given

NUMERATOR NOTE Denominator Exception(s) are determined at the time of the denominator eligible encounter during the current flu season.

Denominator

All patients aged 6 months and older seen for a visit between October 1 and March 31

DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the PFS (Physician Fee Schedule). These non-covered services will not be counted in the denominator population for claims-based measures.

Eligible cases are determined and must be reported, if either of the following conditions

Option 1 – Denominator Criteria (Eligible Cases):

Patients aged ≥ 6 months on date of encounter seen for a visit between October 1 and March 31

AND

Patient encounter – January thru March and/or October thru December (CPT or HCPCS): 90945, 90947, 90951, 90952, 90953, 90954, 90955, 90956, 90957, 90958, 90959, 90960, 90961, 90962, 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 96160, 96161, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*, 99304, 99305, 99306, 99307,  99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335,99336, 99337, 99341, 99342, 99343, 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*, 99429*, 99512*, G0438, G0439
WITHOUT:
Telehealth Modifier: GQ, GT, 95, POS 02

 

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