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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
111 0000 Process Yes Community/Population Health Claims

Measure Description

Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine

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 eligible clinicians who perform the quality actions described in the measure based on services provided and the measure-specific denominator coding

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 have ever received a pneumococcal vaccination

Numerator Instructions:

Data not available

Numerator Quality-Data Coding Options

Denominator Exclusion: G9707:

Patient receiving Hospice Services, Patient Not Eligible

Patient received hospice services any time during the measurement period

Performance Met: CPT II 4040F:
Pneumococcal Vaccination Administered or Previously Received

Pneumococcal vaccine administered or previously received

Performance Not Met: 4040F with 8P:
Pneumococcal Vaccination not Administered or Previously Received, Reason not Otherwise Specified

Append a submission modifier (8P) to CPT Category II code 4040F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified

Pneumococcal vaccine was not administered or previously received, reason not otherwise specified

NUMERATOR NOTE  While the measure provides credit for adults 65 years of age and older who have ever received either the PCV13 or PPSV23 vaccine (or both), according to ACIP recommendations, patients should receive both vaccines. The order and timing of the vaccinations depends on certain patient characteristics, and are described in more detail in the ACIP recommendations.

Denominator

Patients 65 years of age and older with a visit during the measurement period

DENOMINATOR NOTE:  This measure assesses whether patients 65 years of age or older have received one or more pneumococcal vaccinations.

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

Option 1 – Denominator Criteria (Eligible Cases):

Patients aged ≥ 65 years on date of encounter

AND

Patient encounter during the performance period (CPT or HCPCS): 99201, 99202, 99203, 99204,
99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350,
G0402, G0438, G0439

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