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  2. CQM-6914

CMS117v12 - PCV20 Mapping Unspecified Formulation Code - Concern for State Registry Data Integrity

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      Thank you for your inquiry regarding CMS117v12 (Childhood Immunization Status).

      As indicated in known issue EKI-27, specific to 2024 reporting of the PCV20 pneumococcal vaccine formulation, the ‘Pneumococcal Conjugate Vaccine’ value set (OID: 2.16.840.1.113883.3.464.1003.196.12.1221) does not include CVX code 216 for reporting year 2024.

      To meet numerator requirements, implementers can either map PCV20 to the ‘pneumococcal vaccine, unspecified formulation’ (CVX code 109) or the ‘Pneumococcal Conjugate, unspecified formulation’ (CVX code 152), as a workaround. If this mapping is conducted, you should maintain documentation of the mapping, in case of a CMS audit. We are unable to update the published value set for 2024 reporting; however, please note that CVX code 216 is included in the published value set for 2025 reporting. We are unable to advise on code mappings for state registry reporting and would suggest you direct these concerns to your state registry.
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      Thank you for your inquiry regarding CMS117v12 (Childhood Immunization Status). As indicated in known issue EKI-27 , specific to 2024 reporting of the PCV20 pneumococcal vaccine formulation, the ‘Pneumococcal Conjugate Vaccine’ value set (OID: 2.16.840.1.113883.3.464.1003.196.12.1221) does not include CVX code 216 for reporting year 2024. To meet numerator requirements, implementers can either map PCV20 to the ‘pneumococcal vaccine, unspecified formulation’ (CVX code 109) or the ‘Pneumococcal Conjugate, unspecified formulation’ (CVX code 152), as a workaround. If this mapping is conducted, you should maintain documentation of the mapping, in case of a CMS audit. We are unable to update the published value set for 2024 reporting; however, please note that CVX code 216 is included in the published value set for 2025 reporting. We are unable to advise on code mappings for state registry reporting and would suggest you direct these concerns to your state registry.
    • CMS0117v12
    • This will effect the data integrity of state immunization registries and/or the eCQM performance.

      As noted, CMS recommended to the map the use of 20-valent pneumococcal conjugate vaccine (PCV20) (CVX code 216) to the 'pneumococcal vaccine, unspecified formulation' code (CVX code 109) or the 'Pneumococcal Conjugate, unspecified formulation' code (CVX code 152) in the 'Pneumococcal Conjugate Vaccine' (OID: 2.16.840.1.113883.3.464.1003.196.12.1221) value set for the 2023 and 2024 performance year.

      Clients are concerned about mapping the PCV20 to the unspecified formula, because this may hinder the integrity of the immunization data reported to the state registry. They feel that this will not provide correct and accurate data to the state. However, they want to meet the eCQM measure requirements.

      Since this will effect the state registries, are there any plans for an urgent exception to add this CVX code 216 to the data set for the 2024 performance year? If not, what would be the recommendation, given the state registry issue?

       

      Related tickets (EKI-27, CQM-6663)

            edave Mathematica EC eCQM Team
            harveycr Crystal Harvey
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