Updated January 2019. 2019 additions in red.
- IRIS Registry EHR: groups and individuals
- IRIS Registry manual data entry: groups and individuals
- EHR through your vendor (if offered): groups and individuals
- Claims-based reporting: small practices only (group and individual)
Measure Type: Process
NQS Domain: Community/Population Health
Meaningful Measure Area: Preventive Care
2019 additions in red.
This measure is to be reported a minimum of once for visits for patients seen between Oct. 1 and March 31, who are aged 6 months and older, who received an influenza immunization or who reported previous receipt of an influenza immunization.
This measure is to be submitted for a minimum of once for visits for patients seen between January and March for the 2018-2019 influenza season and a minimum of once for visits for patients seen between October and December for the 2019-2020 influenza season.
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).
To Which Patients Does the Measure Apply?
Denominator: All patients, aged 6 months and older, seen for a visit during the measurement period.
There are two criteria for inclusion of a patient into the denominator.
- Patient characteristics: Description located in “Instructions” (see above).
- Procedure codes (CPT and HCPCS): Codes located in “CPT Codes” and “HCPCS Code.”
The quality measure also has exclusions for the denominator.
2019 additions in red.
For registry reporting: Patient encounter during January thru March and/or October thru December (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439
Exclusion: Patient received hospice services any time during the measurement period: G9707
For claims or registry reporting: 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, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*, 99304, 99305,99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335,99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99381*, 99382*, 99383*, 99384*, 99385*, 99386*, 99387*, 99391*, 99392*, 99393*, 99394*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, 99512*, G0438, G0439
Deleted: 96160, 96161
Note: Eye codes 92002, 92004, 92012 and 92014 are not included in this measure.
Without Telehealth Modifier: GQ, GT, 95, POS 2.
*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 registry-based measures.
For the purposes of the program, in order to submit on the flu season 2018-2019, the patient must have a qualifying encounter between Jan. 1 and March 31, 2019. In order to submit on the flu season 2019-2020, the patient must have a qualifying encounter between Oct. 1 and Dec. 31, 2019. A qualifying encounter needs to occur within the flu season that is being submitted; any additional encounter(s) may occur at any time within the measurement period.
How to Report the Measure
Claims and IRIS Registry Manual Reporting
Measure Reporting via Claims: Submit the listed CPT or HCPCS codes, and the appropriate numerator quality-data code. All measure-specific coding should be reported on the claim(s) representing the eligible encounter.
Numerator: Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization
If submitting this measure between Jan. 1, 2019 and March 31, 2019, quality-data code G8482 should be submitted when the influenza immunization is administered to the patient during the months of August, September, October, November, and December of 2018 or January, February, and March of 2019 for the flu season ending March 31, 2019.
If submitting this measure between Oct. 1, 2019 and Dec. 31, 2019, quality-data code G8482 should be submitted when the influenza immunization is administered to the patient during the months of August, September, October, November, and December of 2019 for the flu season ending March 31, 2020.
Influenza immunizations administered during the month of August or September of a given flu season (either 2019-2019 flu season OR 2019-2020 flu season) can be submitted when a visit occurs during the flu season (Oct. 1 - March 31). In these cases, submit G8482.
Numerator note: Denominator Exception(s) are determined at the time of the denominator eligible encounter during the current flu season.
Numerator Instructions: The numerator for this measure can be met by submitting 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 submit a valid denominator exception for having not administered an influenza vaccination. For eligible clinicians submitting 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. As a result of updated CDC/ACIP guidelines which include the interim recommendation that live attenuated influenza vaccine (LAIV) should not be used due to low effectiveness against influenza A(H1N1)pdm09 in the United States during the 2013–14 and 2015–16 seasons, LAIV or intranasal flu vaccine is no longer an option for numerator eligibility.
- Performance met (patient included in numerator and denominator): G8482 Influenza immunization administered or previously received
- Denominator exception (patient not included in numerator or denominator): G8483 Influenza immunization was not administered for reasons documented by clinician (eg, patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)
- Performance not met (patient not included in numerator, but included in denominator): G8484 Influenza immunization was not administered, reason not given
IRIS Registry EHR Reporting
Instructions: Percentage of patients aged 6 months and older seen for a visit between Oct. 1 and March 31 who received an influenza immunization or who reported previous receipt of an influenza immunization.
These are the required elements to be documented at least once a year to meet the measure performance requirements.
- Reporting history of the patient receiving an influenza vaccine between Oct. 1, 2018 and March 31, 2019 or administration of influenza vaccine.
How CMS Scores Your Performance
- If you successfully report a measure for less than 60 percent of your patients, you will earn points based on your practice size:
- Small practices (≤ 15 clinicians) will receive 3 points,
- Larger practices (> 15 clinicians) will receive 1 point.
- If you successfully report a measure for at least 60 percent of your patients, but do not report at least 20 cases, you will receive 3 points.
- If you report this measure for at least 60 percent of applicable patients and on at least 20 patients during a reporting period, you will earn points based on the decile that corresponds to your performance rate. Not all measures offer points for every decile.
||EHR (including EHR-IRIS integration)
||IRIS Registry web portal (No EHR)
||15.50 – 23.63
||29.85 – 41.42
||29.52 – 41.41
||23.64 – 31.20
||41.43 – 53.84
||41.42 – 56.31
||32.21 – 38.65
||53.85 – 66.02
||56.32 – 71.18
||38.66 – 46.76
||66.03 – 76.93
||71.19 – 82.88
||46.77 – 56.01
||76.94 – 87.80
||82.89 – 94.14
||56.02 – 67.49
||87.81 – 96.40
||94.15 – 99.41
||67.50 – 84.98
||96.41 – 99.99
||99.42 – 99.99