Measure 493
Adult Immunization Status
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; and pneumococcal.
| MEASURE ID: | 493 |
|---|---|
| Type: | Process |
CMS Derm Specialty Set: | Yes |
| High priority: | No |
| Topped out: | No |
| Telehealth Eligible: | No |
| Reporting methods: | Registry/QCDR |
| Maximum points: | 10 |
MEASURE PURPOSE:
The purpose of this measure is to improve adult immunization rates by assessing the percentage of patients aged 19 and older who are up-to-date on recommended vaccines for influenza, Td/Tdap, zoster, and pneumococcal. By promoting adherence to evidence-based immunization guidelines, the measure aims to reduce the burden of vaccine-preventable diseases and enhance population health outcomes.
Measure 493 FAQs
Q: What is the purpose of Quality ID #493?
A: This measure tracks the percentage of patients aged 19 and older who are up-to-date on recommended routine vaccines, including influenza, Td or Tdap, zoster, and pneumococcal vaccines.
Q: What are the four performance rates for this measure?
A:
Percentage of patients aged 19 and older who received an influenza vaccine during the measurement period.
Percentage of patients aged 19 and older who received at least one Td or Tdap vaccine within the last 9 years.
Percentage of patients aged 50 and older who received 2 doses of the herpes zoster vaccine after their 50th birthday.
Percentage of patients aged 66 and older who received any pneumococcal vaccine after their 19th birthday.
Q: Who is eligible for this measure?
A: This measure applies to patients aged 19 years and older who have an encounter during the performance period, with exclusions for patients receiving hospice services.
Q: What are the requirements for submitting this measure?
A:
This measure must be submitted a minimum of once per performance period for eligible patients.
It can be submitted by individual clinicians, groups, or third-party intermediaries.
Data submission includes all four performance rates, which are combined to calculate performance using a weighted average.
Q: Can telehealth encounters be included in this measure?
A: Yes, telehealth encounters (e.g., coded with GQ, GT, POS 02, POS 10) are allowable for this measure. However, note that some denominator codes may no longer be eligible due to changes in the CY 2024 PFS Final Rule.
Q: What are the denominators for each performance rate?
A:
Denominator 1: Patients 19 years and older who had a visit during the performance period.
Denominator 2: Patients 19 years and older who received a Td or Tdap vaccine in the past 9 years.
Denominator 3: Patients 50 years and older who received 2 doses of the herpes zoster vaccine.
Denominator 4: Patients 66 years and older who received a pneumococcal vaccine.
Q: How is performance calculated for this measure?
A: A weighted average is used to calculate performance. The sum of the numerator values (patients meeting vaccine requirements) is divided by the sum of the denominator values (eligible patients).
Q: What codes are used for denominator and numerator reporting?
A: Specific CPT codes are used for denominator reporting, including common office visit codes like 99202-99215. Numerator reporting includes codes for each vaccine received by the patient.
Q: What documentation is needed to meet the numerator criteria?
A:
Patient-reported vaccine receipt is acceptable if recorded in the medical record.
For exceptions (e.g., medical contraindications), document the reason for not administering the vaccine.
Q: Are there any exclusions for this measure?
A: Yes, patients in hospice or using hospice services during the measurement period are excluded from the denominator.
Q: What vaccines are covered by this measure?
A: The vaccines covered by this measure include:
Influenza
Tetanus and diphtheria (Td) or Tetanus, diphtheria, and acellular pertussis (Tdap)
Herpes zoster (zoster)
Pneumococcal conjugate or polysaccharide vaccine
Q: Where can I find additional resources for submitting this measure?
A: For more details on data submission and API information, visit the Quality Payment Program (QPP) website.
Calculation
The numerator: Patients who are up-to-date on recommended vaccines for influenza, Td/Tdap, zoster, and pneumococcal.
The denominator: Patients aged 19 years and older on the date of the encounter with at least one eligible encounter during the performance period.
Important note
Because of how this measure is structured, a score of 53.11% earns 9.9 points, while a score of 53.12% and above earns 10 points.
Quality measure score benchmark
CMS will award points based on a comparison of your performance rate to CMS benchmarks listed below. Reach the performance rate listed to achieve the corresponding points per measure. Points achieved for the Quality category will account for 30% of the overall MIPS score.
Benchmarks for registry submissions
The table below shows CMS benchmarks for registry submissions.
Decile 1 | Decile 2 | Decile 3 | Decile 4 | Decile 5 | Decile 6 | Decile 7 | Decile 8 | Decile 9 | Decile 10 | |
|---|---|---|---|---|---|---|---|---|---|---|
Performance rate |
0.02 - 0.23 |
0.24 - 2.27 |
2.28 - 7.42 |
7.43 - 13.20 |
13.21 - 18.75 |
18.76 - 24.96 |
24.97 - 31.87 |
31.88 - 37.38 |
37.39 - 53.11 |
>= 53.12 |
Points |
1.0 - 1.9 |
2.0 - 2.9 |
3.0 - 3.9 |
4.0 - 4.9 |
5.0 - 5.9 |
6.0 - 6.9 |
7.0 - 7.9 |
8.0 - 8.9 |
9.0 - 9.9 |
10 |
