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  2. CQM-5335

CMS 127 - Pneumococcal Vaccine for Older Adults

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      ​​Thank you for your inquiry about the logic for CMS127v11. The measure logic will pull in documentation of pneumococcal vaccination received on or after a patient's 60th birthday and before the end of the measurement. The measure requires documentation via QDM v5.5 datatypes "Immunization, Administered" with any codes listed in the "Pneumococcal Polysaccharide 23 Vaccine" value set (2.16.840.1.113883.3.464.1003.110.12.1089), or "Procedure, Performed" with the CPT Code (90732) Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use. For the performance year 2022, implementers may map additional formulations of the pneumococcal conjugate vaccine, including pneumococcal conjugate vaccine 13 valent, pneumococcal conjugate vaccine 15 valent, and pneumococcal conjugate vaccine 20 valent, to the pneumococcal vaccine, unspecified formulation code (CVX code 109) in the Pneumococcal Polysaccharide 23 Vaccine (OID: 2.16.840.1.113883.3.464.1003.110.12.1089) value set.
      Show
      ​​Thank you for your inquiry about the logic for CMS127v11. The measure logic will pull in documentation of pneumococcal vaccination received on or after a patient's 60th birthday and before the end of the measurement. The measure requires documentation via QDM v5.5 datatypes "Immunization, Administered" with any codes listed in the "Pneumococcal Polysaccharide 23 Vaccine" value set (2.16.840.1.113883.3.464.1003.110.12.1089), or "Procedure, Performed" with the CPT Code (90732) Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use. For the performance year 2022, implementers may map additional formulations of the pneumococcal conjugate vaccine, including pneumococcal conjugate vaccine 13 valent, pneumococcal conjugate vaccine 15 valent, and pneumococcal conjugate vaccine 20 valent, to the pneumococcal vaccine, unspecified formulation code (CVX code 109) in the Pneumococcal Polysaccharide 23 Vaccine (OID: 2.16.840.1.113883.3.464.1003.110.12.1089) value set.
    • CMS0127v11
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      CMS 127 - Pneumococcal Vaccine for Older Adults: The 2022 logic specifies that only Pneumococcal Polysaccharide Vaccine 23 meet the measure. However, the measure description still reads as patients 66 and older are to receive one vaccine (no specified vaccine type). Are you aware that not including the other pneumococcal vaccines drastically reduces the providers' performance score? Will you consider changing the logic back to include the other vaccines to meet MIPS in 2022?
      Show
      CMS 127 - Pneumococcal Vaccine for Older Adults: The 2022 logic specifies that only Pneumococcal Polysaccharide Vaccine 23 meet the measure. However, the measure description still reads as patients 66 and older are to receive one vaccine (no specified vaccine type). Are you aware that not including the other pneumococcal vaccines drastically reduces the providers' performance score? Will you consider changing the logic back to include the other vaccines to meet MIPS in 2022?

      CMS 127 - Pneumococcal Vaccine for Older Adults: The 2022 logic specifies that only Pneumococcal Polysaccharide Vaccine 23 meet the measure. However, the measure description still reads as patients 66 and older are to receive one vaccine (no specified vaccine type). Are you aware that not including the other pneumococcal vaccines drastically reduces the providers' performance score? Will you consider changing the logic back to include the other vaccines to meet MIPS in 2022?

      Additional points:
      The CDC’s Advisory Committee on Immunization Practices (ACIP) on 10/20/21 recommended Prevnar-15 or Prevnar-20 for Prevnar-naïve adults aged >/= 65 years old or 19-64 with certain underlying conditions. When PCV15 is used it should be followed by PPSV23 >/=1 year later.

      So, the updated ACIP guidelines indicate that many individuals >/= age 65 will not need PPSV23, so it does not make sense to create a metric focusing on PPSV23.

      Here is the report in the CDC’s journal “Morbidity and Mortality Weekly Report” (MMWR) on 1/28/22
      https://www.cdc.gov/mmwr/volumes/71/wr/mm7104a1.htm?s_cid=mm7104a1_w

            edave Mathematica EC eCQM Team
            temmo1 Moyna P Temple
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