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    Measure 474: Zoster (Shingles) Vaccination


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    New in 2019. Updated March 2019. This measure is not available for MIPS reporting beginning in 2020.

    Reporting Options: 

    • IRIS Registry manual entry: groups and individuals

    Measure Type: Process

    Meaningful Measure Area: Preventive Care

    Instructions: This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. There is no diagnosis associated with this measure. This measure may be submitted by Merit- based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided may submit this measure.

    This measure is appropriate for use in ambulatory/office-based settings. For each of these settings, there should be documentation in the medical record(s) that the Shingrix zoster vaccination was ever administered.

    To Which Patients Does this Measure Apply?

    Denominator: All patients aged 50 years and older. 

    There are two criteria for inclusion of a patient into the denominator.

    1. Patient characteristics: Description located in “Instructions” (see above).
    2. Procedure codes (CPT and HCPCS): Codes located in “CPT Codes” and “HCPCS Codes.”
    The quality measure also has exclusions for the denominator.

    CPT Codes:

    99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99324,99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99495, 99496, G0402, G0438, G0439

    WITHOUT:  Telehealth Modifier: GQ, GT, 95, POS 02

    AND NOT

    DENOMINATOR EXCLUSION: 

    Patient pregnancy: M1061
    OR
    Patient immunocompromised: M1062
    OR
    Patients receiving high doses of immunosuppressive therapy: M1063

    How to Report the Measure

    IRIS Registry Manual Reporting

    Numerator: Patients who have had a full course of the Shingrix zoster (shingles) vaccination ever documented in the medical record

    • Performance Met: M1064 Shingrix vaccine documented as administered or previously received

    • Denominator Exception: M1065 Shingrix vaccine was not administered for reasons documented by clinician (e.g. patient administered vaccine other than Shingrix, patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)

    • Performance Not Met: M1066 Shingrix vaccine not documented as administered, reason not given

    Numerator Note: The numerator is determined by examining immunization data recorded in the electronic health record, either in the immunization record, the procedures list of immunization administration/injection, and in the medication record of the vaccine. The quality action for this measure is not limited to the performance period since this vaccination may occur once within a patient’s lifetime. It is appropriate to review the patient medical history to determine if this vaccination was administered. Vaccinations administered on the denominator eligible encounter would also meet performance.

    In order to meet performance for this measure, Shingrix must be administered according to the clinical guidelines which consists of 2 documented doses, administered intramuscularly, 2-6 months apart. If the clinician assesses the patient in October thru December of the current measurement year and is unable to administer 2 doses, then it would be appropriate to submit the denominator exception M1065.

    Clinical Recommendation Statements: 

     

    The Advisory Committee on Immunization Practices (ACIP) of the CDC recommends Zoster (shingles) vaccine for adults aged 50 years and older. The measure is not currently endorsed by the NQF, however, the NQF deems zoster vaccine as a priority. Vaccination can reduce the incidence of infection of herpes zoster (shingles) and/ or its complications of chronic pain due to postherpetic neuralgia (PHN), and prolonged or permanent pain, facial scarring, and loss of vision due to eye involvement of the infection, and hospitalizations due to its complications. The CDC ACIP first recommended the Zostavax vaccine in 2008. Zoster Vaccine Recombinant, Adjuvanted (Shingrix) was approved on October 20, 2017 by the Food and Drug Administration for the prevention of herpes zoster in adults aged >=50 years. The vaccine consists of 2 doses, administered intramuscularly, 2-6 months apart. The ACIP (Advisory Committee on Immunization Practices) recommends use of the Shingrix vaccine over the Zoster Vaccine Live (Zostavax) vaccine for the prevention of herpes zoster and related complications. Shingrix is also recommended for patients preciously vaccinated with Zostavax.

    How CMS Scores Your Performance

    • No scoring benchmark currently exists for this measure.
    • If 19 or fewer physicians each report the measure or 20 physicians do not report the measure on at least 60 percent of qualifying patients, and a minimum of 20 patients, you will earn 3 out of 10 points toward your total quality score. 
    • Choose this assuming you’ll only earn 3 points.
    • If at least 20 physicians report the measure on at least 60 percent of qualifying patients and at least 20 patients, CMS will develop a scoring benchmark using data collected during the 2018 reporting year.

    How CMS Scores Your Performance

    No scoring benchmark currently exists for this QCDR measure.

    If 19 or fewer physicians each report the measure or 20 physicians do not report the measure on at least 60 percent of qualifying patients, and a minimum of 20 patients, you will earn 3 out of 10 points toward your total quality score. Choose measures assuming you’ll only earn 3 points.

    If at least 20 physicians report the measure on at least 60 percent of qualifying patients and at least 20 patients, CMS will develop a scoring benchmark using data collected during the 2019 reporting year.