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; pneumococcal; and hepatitis B.
| MEASURE ID: | 493 |
|---|---|
| Type: | Process |
CMS Derm Specialty Set: | No |
| High priority: | No |
| Topped out: | -- |
| Telehealth Eligible: | No |
| Reporting methods: | Registry/QCDR |
| Maximum points: | -- |
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, pneumococcal, and hepatitis B. 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, pneumococcal vaccines, and hepatitis B vaccines.
Q: What are the five performance rates for this measure?
A:
Percentage of patients aged 19 and older 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.
Percentage of patients aged 19 and older who received at least one Td or Tdap vaccine between 9 years prior to the encounter and the end of the measurement period.
Percentage of patients aged 50 and older who received 2 doses of the herpes zoster vaccine anytime from Oct. 20, 2017, through the end of the measurement period.
Percentage of patients aged 66 and older who received any pneumococcal vaccine on or after their 19th birthday and before the end of the measurement period.
Percentage of patients 19 and older who were administered a hepatitis B vaccine series.
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 five 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 are allowable for this measure.
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:
Administering the vaccine.
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
Hepatitis B vaccine series
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, pneumococcal, and hepatitis B.
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
CMS has not set benchmarks for this measure due to substantive changes to the measure specification in PY 2026; PY 2026 measure can’t be compared to baseline period (PY 2024) measure. Because of this, physicians score 3 points if they report on only one patient if they are a small practice with 15 providers or fewer.
