FY 2017 MDHHS Deliverable Submission Form - … 2017 MDHHS Deliverable Submission Form . ... 3 dose...
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FY 2017 MDHHS Deliverable Submission Form Name of Project: Michigan Care Improvement Registry Support Project Document Name: Supported Vaccine Codes Project Number: J-64274 Program Name: Center for Social Enterprise Director or Coordinator Name: Jeff Allison Submitted By: Karen McGettigan Type of Deliverable: (Please check one) Final report Specialized report Publication Articles published Brochures Software application Web screen shot No report, publication, or study Deliverable pending OTHER material If OTHER, please describe: Supported Vaccine Codes is updated as new code information is available. https://www.mcir.org/wp-content/uploads/2014/09/All_Vaccine_codes.pdf
Transcript of FY 2017 MDHHS Deliverable Submission Form - … 2017 MDHHS Deliverable Submission Form . ... 3 dose...
FY 2017 MDHHS Deliverable Submission Form
Name of Project: Michigan Care Improvement Registry Support Project
Document Name: Supported Vaccine Codes
Project Number: J-64274
Program Name: Center for Social Enterprise
Director or
Coordinator Name:
Jeff Allison
Submitted By: Karen McGettigan
Type of Deliverable: (Please check one)
Final report
Specialized report
Publication
Articles published
Brochures
Software application
Web screen shot
No report, publication, or study
Deliverable pending
OTHER material If OTHER, please describe:
Supported Vaccine Codes is updated as new code information is available.
https://www.mcir.org/wp-content/uploads/2014/09/All_Vaccine_codes.pdf
Supported MCIR Vaccine Codes Including U.S. Licensed CVX, CPT-4, and MVX MCIR codes are a reflection, but not a complete list of, those maintained at the CDC National Immunization Program
website:http://www2a.cdc.gov/vaccines/IIS/IISStandards/vaccines.asp?rpt=cvx
*Bold = Updated or New Information MCIR codes are a reflection, but not a complete list of, those maintained at the CDC National Immunization Program website:http://www2a.cdc.gov/vaccines/IIS/IISStandards/vaccines.asp?rpt=cvx MCIR Helpdesk at MPHI Page 1 07-20-2017
CDC Vaccine Code (CVX)
MCIR Vaccine Display Name
CDC Product Name CDC Vaccine Name
CDC Current Procedural Terminology Code (CPT Code)
MANUFACTURER
Manufacturer Code (MVX)
24 Anthrax BIOTHRAX Anthrax 90581 BioPort MIP
19 BCG MYCOBAX BCG: Bacilus of Calmette & Guerin 90728 Sanofi PMC
TICE BCG BCG: Bacilus of Calmette & Guerin 90585 Organon teknika
OTC
27 Botulinum Antitoxin Botulinum Antitoxin 90287
29 CMVIG (IV) CMVIG (IV): Cytomegalovirus globulin
90291 MAPH MA
12 Diphtheria antitoxin 90296
28 DT (pediatric) DT (GENERIC) Diphtheria-Tetanus (DT pediatric) 90702 Sanofi PMC
106 DTaP DAPTACEL DTaP (5 pertussis) None Sanofi PMC
20 DTaP (Pediatric) TRIPEDIA DTaP 90700 Sanofi PMC
INFANRIX DTaP 90700 GlaxoSmithKline SKB
110 DTaP-HepB-IPV (Pediarix)
PEDIARIX DTaP-HepB-IPV 90723 GlaxoSmithKline SKB
50 DTaP-Hib TRIHIBIT DTaP-Hib 90721 Sanofi PMC
120 DTaP-Hib-IPV (Pentacel)
PENTACEL DTaP-Hib-IPV 90698 Sanofi PMC
130 DTaP-IPV KINRIX DTaP-IPV 90696 GlaxoSmithKline SKB
130 DTaP-IPV Quadracel DTaP-IPV 90696 Sanofi PMC
30 HBIG: HepB globulin HBIG: Hep B globulin 90371 NABI NAB
52 HepA (adult) HAVRIX-ADULT Hepatitis A adult (HepA) 90632 GlaxoSmithKline SKB
VAQTA-ADULT Hepatitis A adult (HepA) 90632 Merck MSD
83 HepA (ped/adol) HAVRIX-PEDS Hepatitis A pediatric (HepA) 90633 GlaxoSmithKline SKB
VAQTA-PEDS Hepatitis A pediatric (HepA) 90633 Merck MSD
104 HepA-HepB (Twinrix) TWINRIX Hepatitis A-Hepatitis B (HepA-HepB)
90636 GlaxoSmithKline SKB
43 HepB (adult) RECOMBIVAX-ADULT
Hepatitis B adult (HepB) 90746 Merck MSD
43 HepB (adult) RECOMBIVAX-ADULT
Hepatitis B adolescent (2 dose) 90743 Merck MSD
43 Hep B (adult) ENGERIX-B-ADULT Hepatitis-B adult (HepB) 90746 GlaxoSmithKline SKB
44 HepB (dialysis)
RECOMBIVAX-DIALYSIS
Hepatitis B (dialysis) 3 dose 90740 Merck MSD
Engergix-B-DIALYSIS Hepatitis B (dialysis) 4 dose 90747 GlaxoSmithKline
SKB
Supported MCIR Vaccine Codes Including U.S. Licensed CVX, CPT-4, and MVX MCIR codes are a reflection, but not a complete list of, those maintained at the CDC National Immunization Program
website:http://www2a.cdc.gov/vaccines/IIS/IISStandards/vaccines.asp?rpt=cvx
*Bold = Updated or New Information MCIR codes are a reflection, but not a complete list of, those maintained at the CDC National Immunization Program website:http://www2a.cdc.gov/vaccines/IIS/IISStandards/vaccines.asp?rpt=cvx MCIR Helpdesk at MPHI Page 2 07-20-2017
CDC Vaccine Code (CVX)
MCIR Vaccine Display Name
CDC Product Name CDC Vaccine Name
CDC Current Procedural Terminology Code (CPT Code)
MANUFACTURER
Manufacturer Code (MVX)
08 HepB (ped/adol) ENGERIX B-PEDS Hepatitis B pediatric or adolescent 90744 GlaxoSmithKline SKB
RECOMBIVAX-PEDS Hepatitis B pediatric or adolescent 90744 Merck MSD
48 Hib (ActHib/Hiberix) ACTHIB
Haemophilus influenzae type b (Hib)
90648 Sanofi (ActHIB) PMC
HIBERIX Haemophilus influenzae type b (Hib)
90648 Glaxo (HIBERIX) SKB
49 Hib (PedvaxHIB) PEDVAXHIB Haemophilus influenzae type b (Hib)(3dose)
90647 Merck MSD
148 HIBMENCY MENHIBRIX Meningococcal C/Y-HIB PRP 90644 GlaxoSmithKline SKB
118 HPV2 CERVARIX HPV, bivalent (HPV2) 90650 GlaxoSmithKline SKB
62 HPV4 GARDASIL Human Papillomavirus Quadrivalent (HPV4)
90649 Merck MSD
165 HPV9 GARDASIL9 Human Papillomavirus 9-valent vaccine
90651 Merck MSD
87 Immune Globulin - IV Immune Globulin - IV 90283
86 Immune Globulin (IM)
GAMASTAN Immune Globulin - IM 90281 Talecris TAL
140 Influenza IIV3 (P-Free,Inj)
FLUARIX Influenza shot (IIV3) (P-Free, Inject) 90655 90656
GlaxoSmithKline SKB
FLUVIRIN Influenza shot (IIV3) (P-Free, Inject) 90655 90656
Seqirus SEQ
AFLURIA Influenza shot (IIV3) (P-Free, Inject) 90655 90656
CSL CSL
AFLURIA Influenza shot (IIV3) (P-Free, Inject) 90655 90656
Seqirus SEQ
FLUZONE Influenza shot (IIV3) (P-Free, Inject) 90655 90656
Sanofi PMC
141 Influenza IIV3 (inject)
AFLURIA Influenza shot (IIV3) (Inject) 90657 90658
CSL CSL
FLUVIRIN Influenza shot (IIV3) (Inject) 90657 90658
Seqirus SEQ
FLUZONE Influenza shot (IIV3) (Inject) 90657 90658
Sanofi PMC
FLULAVAL Influenza shot (IIV3) (Inject) 90657 90658
ID Biomedical IDB
144 Influenza IIV3 Fluzone, intradermal
Influenza Intradermal IIV3 (P-Free, Intradermal)
90654 Sanofi PMC
Supported MCIR Vaccine Codes Including U.S. Licensed CVX, CPT-4, and MVX MCIR codes are a reflection, but not a complete list of, those maintained at the CDC National Immunization Program
website:http://www2a.cdc.gov/vaccines/IIS/IISStandards/vaccines.asp?rpt=cvx
*Bold = Updated or New Information MCIR codes are a reflection, but not a complete list of, those maintained at the CDC National Immunization Program website:http://www2a.cdc.gov/vaccines/IIS/IISStandards/vaccines.asp?rpt=cvx MCIR Helpdesk at MPHI Page 3 07-20-2017
CDC Vaccine Code (CVX)
MCIR Vaccine Display Name
CDC Product Name CDC Vaccine Name
CDC Current Procedural Terminology Code (CPT Code)
MANUFACTURER
Manufacturer Code (MVX)
168 Influenza IIV3 Fluad Influenza, trivalent, adjuvanted, preservative free
90653 Seqirus SEQ
135 Influenza IIV3 High Dose
FLUZONE-HIGH DOSE
Influenza High Dose (IIV3) 90662 Sanofi PMC
158 Influenza IIV4 (inject)
Flulaval quadrivalent
Influenza shot (IIV4) (Inject) 90688 90687
GlaxoSmithKline SKB
Flulaval quadrivalent
Influenza shot (IIV4) (Inject) 90687 90688
Biomedical IDB
Fluzone Influenza shot (IIV4) (Inject) 90687 90688
Sanofi PMC
161 Influenza IIV4 Ped (P-free, inject)
Fluzone Quadrivalent, pediatric
Influenza Shot (IIV4) (P-Free, Inject) Quadrivalent Pediatric
90685 Sanofi PMC
150 Influenza IIV4 (P-Free,Inj)
Fluarix, Quadrivalent
Influenza Shot (IIV4) (P-Free, Inject) Quadrivalent
90686 GlaxoSmithKline SKB
Fluzone, Quadrivalent
Influenza Shot (IIV4) (P-Free, Inject) Quadrivalent
90686 Sanofi PMC
Flulaval quadrivalent
Influenza Shot (IIV4) (P-Free, Inject) Quadrivalent
90686 Biomedical IDB
166 Influenza IIV4 (P- free, inject) intradermal
Fluzone, Quadrivalent
Influenza, intradermal, quadrivalent, preservative free
90630 Sanofi PMC
171 Influenza ccIIV4 (P-Free, Inj)
Flucelvax quadrivalent
Influenza, injectable, MDCK, preservative free, quadrivalent
90674 Seqirus SEQ
149 Influenza LAIV4 (Flumist)
Flumist quadrivalent
Influenza intranasal (LAIV4) Quadrivalent
90672 Medimmune MED
155 Influenza RIV3 (Flublok, P-Free)
Flublok Influenza RIV3 (P-Free, Inject) (Recombiant HA Trivalent)
90673 Protein Sciences
PSC
10 IPV (polio) IPOL Polio (IPV) 90713 Sanofi PMC
134 Japanese Encephalitis IM
Ixiaro Japanese Encephalitis IM 90738 Valneva VAL
114 MCV4 (Menactra) MENACTRA Meningococcal Conjugate 90734 Sanofi PMC
136 MCV4O (Menveo) MENVEO Meningococcal Oligosaccharide 90734 GlaxoSmithKline SKB
162 Meningococcal B, recombinant
Trumenba Meningococcal B vaccine, fully recombinant
90621 Pfizer PFR
163 Meningococcal B, OMV
Bexsero Meningococcal B vaccine, recombinant, OMV, adjuvanted
90620 GlaxoSmithKline SKB
Supported MCIR Vaccine Codes Including U.S. Licensed CVX, CPT-4, and MVX MCIR codes are a reflection, but not a complete list of, those maintained at the CDC National Immunization Program
website:http://www2a.cdc.gov/vaccines/IIS/IISStandards/vaccines.asp?rpt=cvx
*Bold = Updated or New Information MCIR codes are a reflection, but not a complete list of, those maintained at the CDC National Immunization Program website:http://www2a.cdc.gov/vaccines/IIS/IISStandards/vaccines.asp?rpt=cvx MCIR Helpdesk at MPHI Page 4 07-20-2017
CDC Vaccine Code (CVX)
MCIR Vaccine Display Name
CDC Product Name CDC Vaccine Name
CDC Current Procedural Terminology Code (CPT Code)
MANUFACTURER
Manufacturer Code (MVX)
03 MMR M-M-R II MMR 90707 Merck MSD
94 MMRV (ProQuad) PROQUAD MMRV 90710 Merck MSD
32 MPSV4 (Menomune) MENOMUNE Meningococcal Polysaccharide (MPSV4)
90733 Sanofi PMC
07 Mumps MUMPSVAX Mumps 90704 Merck MSD
133 PCV13 (Prevnar) PREVNAR 13
Pneumococcal Conjugate, 13 valent (PCV13)
90670 Wyeth (Inactive) WAL
PREVNAR 13 Pneumococcal Conjugate, 13 valent (PCV13)
90670 Pfizer PFR
23 Plague Plague 90727
96 PPD Intradermal Tubersol Tuberculin-TST Sanofi PMC
Aplisol Tuberculin-TST (PPD Intradermal) Parkdale PD
33 PPSV23 (Pneumovax) PNEUMOVAX 23 Pneumococcal Polysaccharide (PPSV23)
90732 Merck MSD
40 Rabies (ID injection) RabAvert Rabies (ID) (Intradermal inject) 90676 Chiron CHI
IMOVAX ID Rabies (ID) (Intradermal inject) 90676 Sanofi PMC
175 Rabies-IM Diploid IMOVAX IM Diploid cell culture 90675 Sanofi PMC
176 Rabies-IM Fibroblast
RABAVERT IM Fibroblast culture 90675 GlaxoSmithKline SKB
34 RIG: Rabies globulin
HyperRAB RIG-HIT 90376 Grifols GRF
Imogam RIG 90375 Sanofi PMC
HyperRAB RIG-HT 90376 Talecris TAL
93 RSV-MAB (Synagis) Synagis RSV-MAB IM 90378 Medimmune MED
06 Rubella MERUVAX II Rubella 90706 Merck MSD
119 RV1 (Rotarix) ROTARIX Rotavirus Monovalent (2-dose, Rotarix, RV1)
90681 GlaxoSmithKline SKB
116 RV5 (Rotateq) ROTATEQ Rotavirus Pentavalent (3-dose, Rotateq, RV5)
90680 Merck MSD
75 Smallpox ACAM2000 Smallpox (Vaccinia) None Acambis ACA
75 Smallpox ACAM2000 Smallpox (Vaccinia) None Sanofi Pasteur PMC
09 Td (adult) adsorbed Td (adult) adsorbed Tetanus-diphtheria adult (Td) 90718 90714
Massachusetts Biologic (Td adsorbed PF, Td, Td adsorbed)
MBL
Supported MCIR Vaccine Codes Including U.S. Licensed CVX, CPT-4, and MVX MCIR codes are a reflection, but not a complete list of, those maintained at the CDC National Immunization Program
website:http://www2a.cdc.gov/vaccines/IIS/IISStandards/vaccines.asp?rpt=cvx
*Bold = Updated or New Information MCIR codes are a reflection, but not a complete list of, those maintained at the CDC National Immunization Program website:http://www2a.cdc.gov/vaccines/IIS/IISStandards/vaccines.asp?rpt=cvx MCIR Helpdesk at MPHI Page 5 07-20-2017
CDC Vaccine Code (CVX)
MCIR Vaccine Display Name
CDC Product Name CDC Vaccine Name
CDC Current Procedural Terminology Code (CPT Code)
MANUFACTURER
Manufacturer Code (MVX)
113 Td PF (adol/adult) DECAVAC
Tetanus-diphtheria adult (Td) P-Free
90714 Sanofi PMC
Tenivac Tetanus-diphtheria adult (Td) P-Free
90714 Sanofi PMC
Tetanus-diphtheria adult (Td) P-Free
90714 Massachusetts Biologic
MBL
115 Tdap (adol/adult) ADACEL Tdap (adol/adult) 90715 Sanofi PMC
BOOSTRIX Tdap (adol/adult) 90715 GlaxoSmithKline SKB
13 TIG: Tetanus immune globulin
TIG: Tetanus immune globulin 90389
25 Typhoid (oral VIVOTIF Typhoid (oral) 90690 PaxVax PAX
101 Typhoid ViCPS TYPHIM VI Typhoid 90691 Sanofi PMC
79 Vaccinia IG Vaccinia IG Vaccinia Immune Globulin 90393
21 Varicella (Varivax) VARIVAX Varicella (VAR) 90716 Merck MSD
36 VZIG VZIG: Varicella zoster globulin 90396
37 Yellow Fever YF-VAX Yellow Fever (YF) 90717 Sanofi PMC
183 Yellow Fever Stamaril Yellow Fever-alternative formulation
None Sanofi PMC
121 Zoster (Zostavax) ZOSTAVAX Zoster (Herpes Zoster, Shingles, ZOS)
90736 Merck MSD
Supported MCIR Vaccine Codes Inactive and Unspecified
*Bold = Updated or New Information MCIR codes are a reflection, but not a complete list of, those maintained at the CDC National Immunization Program website:http://www2a.cdc.gov/vaccines/IIS/IISStandards/vaccines.asp?rpt=cvx MCIR Helpdesk at MPHI Page 6 07-20-2017
Vaccine Code (CVX)
MCIR DISPLAY Inactive/ Unspecified
VACCINE NAME
CDC Current Procedural Terminology Code (CPT-4)
26 Cholera Inactive Cholera 90725
51 Comvax (Hib-HepB) Inactive Haemophilus influenzae type b-Hepatitis B (Hib-HepB)
90748
107 DTaP (unspecified) Unspecified Diphtheria, tetanus toxoids and acellular
pertussis vaccine, unspecified
formulation
01 DTP Inactive Diphtheria, tetanus toxoids and pertussis vaccine
90701
22 DTP-Hib Inactive TETRAMUNE DTP-Hib 90720
85 HepA adult (unspecified) Unspecified 90730
84 HepA ped/adol, 3 dose Inactive Hepatitis A vaccine, pediatric/adolescent dosage, 3 dose schedule
90634
42 HepB, adolescent/high risk infant
Inactive RECOMBIVAX HB Hep B, adolescent/high risk infant
90745
45 HepB (unspecified) Unspecified 90731
47 Hib (Hib TITER) Inactive Haemophilus influenzae type b (Hib TITER) 90645
17 Hib (unspecified) Unspecified Hib (unspecified) 90737
46 Hib (Pro HIBIT) Inactive PROHIBIT Haemophilus influenzae type b vaccine, PRP-D conjugate
90646
137 HPV (unspecified) Unspecified tetanus and diphtheria toxoids, not adsorbed, for adult use
111 Influenza LAIV (Flumist) Inactive Flumist- Influenza intranasal (LAIV) 90660
88 Influenza (unspecified) Unspecified 90724
151 Influenza Nasal-(unspecified) Unspecified
153 Influenza ccIIV3 FLUCELVAX Influenza ccIIV3 (P-Free Inject) (manf: NOV) 90661
14 ISG/IgG (unspecified) Unspecified 90741
39 Japanese Encephalitis SC Inactive Japanese Encephalitis (SC) 90735
66 Lyme Vaccine Inactive Lyme Vaccine 90665
05 Measles Inactive Attenuvax Measles 90705
147 MCV4 (unspecified) Unspecified
108 Meningococcal (unspecified) Unspecified Meningococcal
164 Meningococcal B (unspecified)
Unspecified
04 MR(Measles-Rubella) Inactive M/R: Measles-Rubella 90708
02 OPV (Polio) Inactive ORIMUNE poliovirus vaccine, live, oral 90712
182 OPV Unspecified Inactive OPV Unspecified
100 PCV7 (Prevnar) Inactive Prevnar7 Pneumococcal Conjugate (PCV7) 90669
152 PCV unspecified Unspecified
11 Pertussis Inactive Pertussis None
Supported MCIR Vaccine Codes Inactive and Unspecified
*Bold = Updated or New Information MCIR codes are a reflection, but not a complete list of, those maintained at the CDC National Immunization Program website:http://www2a.cdc.gov/vaccines/IIS/IISStandards/vaccines.asp?rpt=cvx MCIR Helpdesk at MPHI Page 7 07-20-2017
Vaccine Code (CVX)
MCIR DISPLAY Inactive/ Unspecified
VACCINE NAME
CDC Current Procedural Terminology Code (CPT-4)
109 Pneumococcal vaccine, unspecified
Unspecified
89 Polio (unspecified) Unspecified
90 Rabies (unspecified) Unspecified 90726
18 Rabies Inactive IMOVAX, Rabavert
74 Rotavirus, Tetravalent Inactive RV7 (Rotoshield)
38 Rubella-Mumps Inactive BiavaxII Rubella/Mumps None
122 RV (unspecified) Unspecified Rotovirus Unspecified
139 Td (adult)inactive-(unspecified) Unspecified Td (adult)
138 Td (adult) Inactive Tetanus and Diphtheria Toxoids, not absorbed, for adult use
35 Tetanus Toxoid, Absorbed Inactive Tetanus Toxoid Adsorbed(TT) 90703
91 Typhoid (unspecified) Unspecified Typhoid (unspecified) 90714
41 Typhoid (Parenteral) Inactive Typhoid 90692
53 Typhoid Parenteral, AKD (U.S. military)
Inactive Typhoid 90693
117 VZIG (IND) Inactive VZIG (IND) None
184 Yellow Fever Unspecified Yellow Fever None
For MCIR HEDIS query results (not used for MCIR reporting)
903 Antiviral: Osteltamivir (Tamiflu)
904 Antiviral: Anamivir (Relenza)
No longer used in MCIR Reporting after March 2011: "Influenza TIV (Historical)"
15 influenza, split (incl. purified surface antigen)
None
No longer used in MCIR Reporting after 1998
31 HepA Pediatric (Unspecified, historical)
None
MCIR does not support electronic submission of H1N1 Influenza
125 Novel Influenza-H1N1-09, nasal
Inactive Influenza virus vaccine, pandemic formulation, live, for intranasal use
126 Novel influenza-H1N1-09, preservative-free
Inactive Influenza virus vaccine, pandemic formulation, split-virus, preservative free, for intramuscular use
127 Novel influenza-H1N1-09 Inactive Influenza virus vaccine, pandemic formulation, split-virus, for intramuscular use
128 H1N1 Influenza Unspecified Inactive
