Reminder: Immunization follow up should be conducted by age 2

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Date: September 22, 2021
To: Health Plan of San Joaquin (HPSJ) Contracted PCPs, Clinics, Pediatrics Offices
From: Health Plan of San Joaquin
Subject: Child Immunization Status UPDATE –
Reminder: Immunization follow up should be conducted by age 2
Business: Medi-Cal Managed Care

Childhood Immunization Status: Combination 10

Providers, please be aware of child HPSJ members turning two years of age before November 2021. 

Please remember:

  • Report all Administered Vaccines into the RIDE (preferred) or CAIR 2 registry within 14 days
  • Document the date of the first hepatitis B vaccination – if given at a hospital please note the hospital’s name

Added for 2020-2021:

  • The requirement that if the LAIV (influenza)vaccination is given it must occur ON the child’s second birthday.

Most common deficiencies in coding and billing occur with: 

  • (Hep B) hepatitis B at birth
  • (RV) Rotavirus 2 dose vs (RV)Rotavirus 3 dose

The Childhood Immunization Status (Combination 10) Measure calculates a rate for each vaccine and ten separate combination rates. These, including billing codes, are listed below. 

All Required Vaccines Before 2nd Birthday 

  1. 4(DTaP) diphtheria, tetanus and acellular pertussis. CPT– 90698,90700,90723
  2. 3- (IPV) polio, CPT– 90698,90713,90723
  3. 1- (MMR) measles, mumps and rubella, CPT– 90707,90710
  4. 3- (Hib) haemophilus influenza type B, CPT– 90644,90648,9698,90748
  5. 3 -(Hep B) hepatitis B, CPT– 90723,90740,90744,9074790748
  6. 1- (VZV) chicken pox, CPT– 90710,90716
  7. 4- (PCV) pneumococcal conjugates-CPT– 90670
  8. 1- (Hep A) hepatitis A, CPT– 90633
  9. 2/3- (RV) rotaviruses; 2 dose_CPT– 90681 or 3 dose_CPT– 90680
  10. 2- (flu) influenza vaccines, CPT- 90655,90657,90662,90673,90685,90686,90688,90689

If you have questions, please contact Provider Services at 1.888.936 PLAN (7526).

Posted on September 22nd, 2021