| Valid Data Submission Method(s) | Measure Type | High Priority Measure? | NQS Domain | Specialty Measure Sets |
|---|---|---|---|---|
| Claims, EHR, CMS Web Interface, Registry | Process | No | Community/Population Health | Allergy/Immunology, Internal Medicine, Obstetrics/Gynecology, Preventive Medicine, General Practice/Family Medicine, Pediatrics |
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
Instruction
This measure is to be reported a minimum of once for visits for patients seen between January and March for the 2016-2017 influenza season AND a minimum of once for visits for patients seen between October and December for the 2017-2018 influenza season. This measure is intended to determine whether or not all patients aged 6 months and older received (either from the reporting eligible clinician or from an alternate care provider) the influenza immunization during the flu season. There is no diagnosis associated with this measure. This measure may be reported by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measurespecific denominator coding.
- If reporting this measure between January 1, 2017 and March 31, 2017, quality-data code G8482 should be reported when the influenza immunization is administered to the patient during the months of August, September, October, November, and December of 2016 or January, February, and March of 2017 for the flu
season ending March 31, 2017. - If reporting this measure between October 1, 2017 and December 31, 2017, quality-data code G8482 should be reported when the influenza immunization is administered to the patient during the months of August, September, October, November, and December of 2017 for the flu season ending March 31, 2018.
- Influenza immunizations administered during the month of August or September of a given flu season (either 2016-2017 flu season OR 2017-2018 flu season) can be reported when a visit occurs during the flu season (October 1 – March 31). In these cases, G8482 should be reported.
Denominator
All patients aged 6 months and older seen for at least two visits or at least one preventive visit during the measurement
period
DENOMINATOR NOTE: For the purposes of the program, in order to report on the flu season 2016-2017, the patient must have a qualifying encounter between January 1 and March 31, 2017. In order to report on the flu
season 2017-2018, the patient must have a qualifying encounter between October 1 and December 31, 2017. At least one of the qualifying encounters needs to occur within the flu season that is being reported; any additional encounter(s) may occur at any time within the measurement period.
*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 registrybased measures.
Denominator Criteria (Eligible Cases):
Patients aged ≥ 6 months seen for a visit between October 1 and March 31
AND
At least two patient encounters with at least one encounter during January thru March and/or October thru December (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350
WITHOUT:
Telehealth Modifier: GQ, GT
OR
At least one 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, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 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
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 reporting 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 report a valid denominator exception for having not administered an influenza vaccination. For eligible clinicians reporting 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.
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 Options:
Performance Met: Influenza immunization administered or previously received (G8482)
OR
Denominator Exception: 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) (G8483)
OR
Performance Not Met: Influenza immunization was not administered, reason not given (G8484)