Vaccine Billing Guide for MetroPlusHealth Members

Adult Immunization/Vaccination

The Adult Immunization Status (AIS) measure captures the percentage of MetroPlusHealth members 19 years of age and older who are up to date on recommended routine vaccines for influenza, tetanus and diphtheria (Td) or tetanus, diphtheria and acellular pertussis (Tdap), zoster and pneumococcal.
The AIS measure uses a newer method of reporting—the HEDIS Electronic Clinical Data Systems (ECDS) method—which uses electronic clinical databases such as electronic health records, health information exchanges, administrative claims systems, electronic pharmacy systems, immunization information systems and disease, and case management registries for reporting.
Vaccination providers in New York City should ensure reporting of vaccinations/immunizations to the City Immunization Registry (CIR) to support consolidation of adult patients’ vaccination records. This helps providers access patients’ immunization records and improve the ability to routinely and accurately assess patients’ vaccination status. Be sure to obtain consent from the patient to report in the CIR.  Maintain documentation in your EHR of vaccine status and patient consent.
Strategies for Improvement

  • Make a strong vaccine recommendation to patients to get vaccinated
  • Explain why vaccines are right for the patient based on age, health status, lifestyle, occupation, or other risk factors
  • Explain why vaccines are important and beneficial to the patient’s health
  • Explain that the vaccine protects the patients and loved ones from not just the flu, but flu related complications – Pneumonia, bronchitis, sinus/ear infections, hospitalizations, and sometimes death
  • Explain the impacts of not getting vaccinations – serious health effects, cost of missing work or obligations, financial costs due to medical care needed
  • Address all patient questions regarding vaccine, side effects, effectiveness, and safety – Be sure to use plain and understandable language
  • Adopt the electronic health records and electronic patient portals (EPP) as this would offer opportunities for improving adult vaccination rates
  • More importantly, get consent from all adult members during vaccination, report and document all immunization in the City Immunization Registry (CIR).

For more information on reporting immunization services, visit NYC Health.

 Medical Billing and Coding
The following list of codes should be used to identify the services included in the AIS measure.

CPT90630; 90653; 90654;

90656; 90658; 90661;

90673; 90674; 90882;

90686; 90688; 90689;

90756

Adult Influenza Vaccine Procedure
CPT90714; 90718Td Vaccine Procedure
CPT90715Tdap Vaccine Procedure
CPT90736Herpes Zoster Live Vaccine Procedure
CPT90750Herpes Zoster Recombinant Vaccine Procedure
CPT90670Pneumococcal Conjugate 13 Vaccine Procedure
CPT90732Pneumococcal Polysaccharide 23 Vaccine Procedure
Vaccine Billing Guide

Updated: March 2019

last updated: April 1, 2022

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