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2025 MIPS Measure Adult COVID-19 Vaccination Status

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2025 COLLECTION TYPE:

MIPS CLINICAL QUALITY MEASURES (CQMS)

‌MEASURE TYPE: Process

‌Description:

Percentage of patients aged 18 years and older seen for a visit during the performance period that are up-to-date on their COVID-19 vaccinations as defined by Centers for Disease Control and Prevention (CDC) recommendations on current vaccination.

‌Instructions:

This measure is to be submitted a minimum of once per performance period for patients aged 18 years and older 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 and the measure-specific denominator coding.

NOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, POS 02, or POS 10 modifiers) are allowable. Please note that effective January 1, 2025, while a measure may be denoted as telehealth eligible, specific denominator codes within the encounter may no longer be eligible due to changes outlined in the CY 2024 PFS Final Rule List of Medicare Telehealth Services.

‌Measure Submission Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third-party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third-party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third-party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

Denominator:

All patients aged 18 years and older seen for a visit during the performance period

DENOMINATOR NOTE: *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 MIPS CQMs.

Denominator Criteria (Eligible Cases):

Patients aged 18 years and older on date of encounter

AND

Patient encounter during the performance period (CPT or HCPCS): 59400, 59510, 59610, 59618, 78012, 78070, 78075, 78102, 78140, 78185, 78195, 78202, 78215, 78261, 78290, 78300, 78305, 78315, 78320, 78414, 78428, 78456, 78458, 78579, 78580, 78582, 78597, 78601, 78630, 78647, 78699, 78708, 78725, 78740, 78801, 78803, 78806, 78999, 90791, 90792, 90832, 90834, 90837, 90839, 90845, 90945, 90947, 90951, 90952, 90953, 90954, 90955, 90956, 90957, 90958, 90959, 90960, 90961, 90962, 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 92002, 92004, 92012, 92014, 92507, 92508, 92521, 92522, 92523, 92524, 92526, 92537, 92538, 92540, 92541, 92542, 92544, 92545, 92548, 92550, 92557, 92567, 92568, 92570, 92588, 92625, 92626, 96116, 96156, 96158, 96159, 97129, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97802, 97803, 97804, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 98960, 98961, 98962, 98966, 98967, 98968, 98970, 98971, 98972, 99024, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99231, 99232, 99233, 99236, 99242*, 99243*, 99244*, 99245*, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99341, 99342, 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*, 99421, 99422, 99423, 99424, 99429*, 99491, 99495, 99496, 99512*, G0101, G0108, G0270, G0271, G0402, G0438, G0439, G0447, G0473, G9054

AND NOT

DENOMINATOR EXCLUSION:

Patient received hospice services any time during the performance period: M1416

‌Numerator:

Patients that are up to date on their COVID-19 vaccinations as defined by CDC recommendations on current vaccination as of the date of the encounter

Definition:

Up to Date – The CDC definition of up to date can be found at https://www.cdc.gov/covid/vaccines/stay-up-to- date.html

Numerator Instruction:

In addition to the CDC webpage included in the up to date definition, a document that catalogs the CDC definition of up to date by date is maintained at https://qpp-cm-prod-content.s3.amazonaws.com/uploads/3087/CDC-COVID- 19-Vaccination-Recommendations.zip

NUMERATOR NOTE: The definition of up to date vaccination status may change over time. Therefore, MIPS eligible clinicians should refer to the definition of up to date per the CDC at the time of the visit to which the measure is applied.

Denominator Exception(s) are determined at the time of the denominator eligible encounter.

Numerator Options:

Performance Met: Patients who are up to date on their COVID-19 vaccinations as defined by CDC recommendations on current vaccination (M1417)

OR

Denominator Exception: Patients who are not up to date on their COVID-19 vaccinations as defined by CDC recommendations on current vaccination because of a medical contraindication documented by clinician (M1418)

OR

Performance Not Met: Patients who are not up to date on their COVID-19 vaccinations as defined by CDC recommendations on current vaccination (M1419)

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