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 Jeff Allison Coordinator Name:

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

CDC Current CDC Manufac Procedural Vaccine MCIR Vaccine Display turer CDC Product Name CDC Vaccine Name Terminology MANUFACTURER Code Name Code Code (CVX) (CPT Code) (MVX) 24 Anthrax BIOTHRAX Anthrax 90581 BioPort MIP

MYCOBAX BCG: Bacilus of Calmette & Guerin 90728 Sanofi PMC 19 BCG Organon TICE BCG BCG: Bacilus of Calmette & Guerin 90585 OTC teknika 27 Botulinum Antitoxin Botulinum Antitoxin 90287 CMVIG (IV): Cytomegalovirus 29 CMVIG (IV) 90291 MAPH MA globulin 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 TRIPEDIA DTaP 90700 Sanofi PMC 20 DTaP (Pediatric) INFANRIX DTaP 90700 GlaxoSmithKline SKB DTaP-HepB-IPV 110 PEDIARIX DTaP-HepB-IPV 90723 GlaxoSmithKline SKB (Pediarix) 50 DTaP-Hib TRIHIBIT DTaP-Hib 90721 Sanofi PMC DTaP-Hib-IPV 120 PENTACEL DTaP-Hib-IPV 90698 Sanofi PMC (Pentacel) 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 HAVRIX-ADULT Hepatitis A adult (HepA) 90632 GlaxoSmithKline SKB 52 HepA (adult) VAQTA-ADULT Hepatitis A adult (HepA) 90632 Merck MSD HAVRIX-PEDS Hepatitis A pediatric (HepA) 90633 GlaxoSmithKline SKB 83 HepA (ped/adol) VAQTA-PEDS Hepatitis A pediatric (HepA) 90633 Merck MSD Hepatitis A-Hepatitis B (HepA- 104 HepA-HepB (Twinrix) TWINRIX 90636 GlaxoSmithKline SKB HepB) RECOMBIVAX- 43 HepB (adult) Hepatitis B adult (HepB) 90746 Merck MSD ADULT RECOMBIVAX- 43 HepB (adult) Hepatitis B adolescent (2 dose) 90743 Merck MSD ADULT 43 Hep B (adult) ENGERIX-B-ADULT Hepatitis-B adult (HepB) 90746 GlaxoSmithKline SKB RECOMBIVAX- Hepatitis B (dialysis) 3 dose 90740 Merck MSD DIALYSIS 44 HepB (dialysis) SKB

Engergix-B-DIALYSIS Hepatitis B (dialysis) 4 dose 90747 GlaxoSmithKline

*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 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

CDC Current CDC Manufac Procedural Vaccine MCIR Vaccine Display turer CDC Product Name CDC Vaccine Name Terminology MANUFACTURER Code Name Code Code (CVX) (CPT Code) (MVX)

ENGERIX B-PEDS Hepatitis B pediatric or adolescent 90744 GlaxoSmithKline SKB 08 HepB (ped/adol) RECOMBIVAX-PEDS Hepatitis B pediatric or adolescent 90744 Merck MSD Haemophilus influenzae type b ACTHIB 90648 Sanofi (ActHIB) PMC (Hib) 48 Hib (ActHib/Hiberix) Haemophilus influenzae type b HIBERIX 90648 Glaxo (HIBERIX) SKB (Hib) Haemophilus influenzae type b 49 Hib (PedvaxHIB) PEDVAXHIB 90647 Merck MSD (Hib)(3dose) 148 HIBMENCY MENHIBRIX Meningococcal C/Y-HIB PRP 90644 GlaxoSmithKline SKB 118 HPV2 CERVARIX HPV, bivalent (HPV2) 90650 GlaxoSmithKline SKB Human Papillomavirus 62 HPV4 GARDASIL 90649 Merck MSD Quadrivalent (HPV4) Human Papillomavirus 9-valent 165 HPV9 GARDASIL9 90651 Merck MSD vaccine 87 Immune Globulin - IV Immune Globulin - IV 90283 Immune Globulin 86 GAMASTAN Immune Globulin - IM 90281 Talecris TAL (IM) 90655 FLUARIX Influenza shot (IIV3) (P-Free, Inject) GlaxoSmithKline SKB 90656 90655 FLUVIRIN Influenza shot (IIV3) (P-Free, Inject) Seqirus SEQ 90656 90655 Influenza IIV3 AFLURIA Influenza shot (IIV3) (P-Free, Inject) CSL CSL 140 90656 (P-Free,Inj) 90655 AFLURIA Influenza shot (IIV3) (P-Free, Inject) Seqirus SEQ 90656 90655 FLUZONE Influenza shot (IIV3) (P-Free, Inject) Sanofi PMC 90656 90657 AFLURIA Influenza shot (IIV3) (Inject) CSL CSL 90658 90657 FLUVIRIN Influenza shot (IIV3) (Inject) Seqirus SEQ 90658 141 Influenza IIV3 (inject) 90657 FLUZONE Influenza shot (IIV3) (Inject) Sanofi PMC 90658 90657 FLULAVAL Influenza shot (IIV3) (Inject) ID Biomedical IDB 90658 Fluzone, Influenza Intradermal IIV3 (P-Free, 144 Influenza IIV3 90654 Sanofi PMC intradermal Intradermal) *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 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

CDC Current CDC Manufac Procedural Vaccine MCIR Vaccine Display turer CDC Product Name CDC Vaccine Name Terminology MANUFACTURER Code Name Code Code (CVX) (CPT Code) (MVX) Influenza, trivalent, adjuvanted, 168 Influenza IIV3 Fluad 90653 Seqirus SEQ preservative free Influenza IIV3 High FLUZONE-HIGH 135 Influenza High Dose (IIV3) 90662 Sanofi PMC Dose DOSE Flulaval 90688 Influenza shot (IIV4) (Inject) GlaxoSmithKline SKB quadrivalent 90687 Flulaval 90687 158 Influenza IIV4 (inject) Influenza shot (IIV4) (Inject) Biomedical IDB quadrivalent 90688 90687 Fluzone Influenza shot (IIV4) (Inject) Sanofi PMC 90688 Fluzone Influenza IIV4 Ped Influenza Shot (IIV4) (P-Free, 161 Quadrivalent, 90685 Sanofi PMC (P-free, inject) Inject) Quadrivalent Pediatric pediatric Fluarix, Influenza Shot (IIV4) (P-Free, 90686 GlaxoSmithKline SKB Quadrivalent Inject) Quadrivalent Influenza IIV4 Fluzone, Influenza Shot (IIV4) (P-Free, 150 90686 Sanofi PMC (P-Free,Inj) Quadrivalent Inject) Quadrivalent Flulaval Influenza Shot (IIV4) (P-Free, Inject) 90686 Biomedical IDB quadrivalent Quadrivalent Influenza IIV4 Fluzone, Influenza, intradermal, 166 (P- free, inject) 90630 Sanofi PMC Quadrivalent quadrivalent, preservative free intradermal Influenza ccIIV4 Flucelvax Influenza, injectable, MDCK, 171 90674 Seqirus SEQ (P-Free, Inj) quadrivalent preservative free, quadrivalent Influenza LAIV4 Flumist Influenza intranasal (LAIV4) 149 90672 Medimmune MED (Flumist) quadrivalent Quadrivalent Influenza RIV3 Influenza RIV3 (P-Free, Inject) Protein 155 Flublok 90673 PSC (Flublok, P-Free) (Recombiant HA Trivalent) Sciences 10 IPV (polio) IPOL Polio (IPV) 90713 Sanofi PMC Japanese 134 Ixiaro Japanese Encephalitis IM 90738 Valneva VAL Encephalitis IM 114 MCV4 (Menactra) MENACTRA Meningococcal Conjugate 90734 Sanofi PMC

136 MCV4O (Menveo) MENVEO Meningococcal Oligosaccharide 90734 GlaxoSmithKline SKB Meningococcal B, Meningococcal B vaccine, fully 162 Trumenba 90621 Pfizer PFR recombinant recombinant Meningococcal B, Meningococcal B vaccine, 163 Bexsero 90620 GlaxoSmithKline SKB OMV recombinant, OMV, adjuvanted

*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 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

CDC Current CDC Manufac Procedural Vaccine MCIR Vaccine Display turer CDC Product Name CDC Vaccine Name Terminology MANUFACTURER Code Name Code Code (CVX) (CPT Code) (MVX) 03 MMR M-M-R II MMR 90707 Merck MSD 94 MMRV (ProQuad) PROQUAD MMRV 90710 Merck MSD Meningococcal Polysaccharide 32 MPSV4 (Menomune) MENOMUNE 90733 Sanofi PMC (MPSV4) 07 Mumps MUMPSVAX Mumps 90704 Merck MSD Pneumococcal Conjugate, 13 PREVNAR 13 90670 Wyeth (Inactive) WAL valent (PCV13) 133 PCV13 (Prevnar) Pneumococcal Conjugate, 13 PREVNAR 13 90670 Pfizer PFR valent (PCV13) 23 Plague Plague 90727 Tubersol Tuberculin-TST Sanofi PMC 96 PPD Intradermal Aplisol Tuberculin-TST (PPD Intradermal) Parkdale PD Pneumococcal Polysaccharide 33 PPSV23 (Pneumovax) PNEUMOVAX 23 90732 Merck MSD (PPSV23) RabAvert Rabies (ID) (Intradermal inject) 90676 Chiron CHI 40 Rabies (ID injection) IMOVAX ID Rabies (ID) (Intradermal inject) 90676 Sanofi PMC 175 Rabies-IM Diploid IMOVAX IM Diploid cell culture 90675 Sanofi PMC Rabies-IM 176 RABAVERT IM Fibroblast culture 90675 GlaxoSmithKline SKB Fibroblast HyperRAB RIG-HIT 90376 Grifols GRF 34 RIG: Rabies globulin Imogam RIG 90375 Sanofi PMC HyperRAB RIG-HT 90376 Talecris TAL 93 RSV-MAB (Synagis) Synagis RSV-MAB IM 90378 Medimmune MED MSD 06 Rubella MERUVAX II Rubella 90706 Merck

Rotavirus Monovalent (2-dose, 119 RV1 (Rotarix) ROTARIX 90681 GlaxoSmithKline SKB Rotarix, RV1) Rotavirus Pentavalent (3-dose, 116 RV5 (Rotateq) ROTATEQ 90680 Merck MSD Rotateq, RV5) 75 Smallpox ACAM2000 Smallpox (Vaccinia) None Acambis ACA 75 Smallpox ACAM2000 Smallpox (Vaccinia) None Sanofi Pasteur PMC Massachusetts 90718 09 Td (adult) adsorbed Td (adult) adsorbed Tetanus-diphtheria adult (Td) Biologic (Td MBL 90714 adsorbed PF, Td, Td adsorbed)

*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 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

CDC Current CDC Manufac Procedural Vaccine MCIR Vaccine Display turer CDC Product Name CDC Vaccine Name Terminology MANUFACTURER Code Name Code Code (CVX) (CPT Code) (MVX) Tetanus-diphtheria adult (Td) P- DECAVAC 90714 Sanofi PMC Free 113 Td PF (adol/adult) Tetanus-diphtheria adult (Td) P- Tenivac 90714 Sanofi PMC Free Tetanus-diphtheria adult (Td) P- Massachusetts 90714 MBL Free Biologic ADACEL Tdap (adol/adult) 90715 Sanofi PMC 115 Tdap (adol/adult) BOOSTRIX Tdap (adol/adult) 90715 GlaxoSmithKline SKB

TIG: Tetanus 13 TIG: Tetanus immune globulin 90389 immune globulin 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 Yellow Fever-alternative 183 Yellow Fever Stamaril None Sanofi PMC formulation Zoster (Herpes Zoster, Shingles, 121 Zoster (Zostavax) ZOSTAVAX 90736 Merck MSD ZOS)

*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 Supported MCIR Vaccine Codes Inactive and Unspecified

Vaccine CDC Current Inactive/ Procedural Code MCIR DISPLAY VACCINE NAME Unspecified Terminology (CVX) Code (CPT-4) 26 Cholera Inactive Cholera 90725 Haemophilus influenzae type b-Hepatitis B 51 Comvax (Hib-HepB) Inactive 90748 (Hib-HepB) Diphtheria, tetanus toxoids and acellular 107 DTaP (unspecified) Unspecified pertussis vaccine, unspecified formulation Diphtheria, tetanus toxoids and pertussis 01 DTP Inactive 90701 vaccine 22 DTP-Hib Inactive TETRAMUNE DTP-Hib 90720 85 HepA adult (unspecified) Unspecified 90730 Hepatitis A vaccine, pediatric/adolescent 84 HepA ped/adol, 3 dose Inactive 90634 dosage, 3 dose schedule HepB, adolescent/high risk RECOMBIVAX HB Hep B, adolescent/high 42 Inactive 90745 infant risk infant 45 HepB (unspecified) Unspecified 90731 47 Hib (Hib TITER) Inactive Haemophilus influenzae type b (Hib TITER) 90645 17 Hib (unspecified) Unspecified Hib (unspecified) 90737 PROHIBIT Haemophilus influenzae type b 46 Hib (Pro HIBIT) Inactive 90646 vaccine, PRP-D conjugate tetanus and diphtheria toxoids, not 137 HPV (unspecified) Unspecified 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 Meningococcal B 164 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 *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 Supported MCIR Vaccine Codes Inactive and Unspecified

Vaccine CDC Current Inactive/ Procedural Code MCIR DISPLAY VACCINE NAME Unspecified Terminology (CVX) Code (CPT-4) Pneumococcal vaccine, 109 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) Tetanus and Diphtheria Toxoids, not 138 Td (adult) Inactive 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 Typhoid Parenteral, AKD 53 Inactive Typhoid 90693 (U.S. military) 117 VZIG (IND) Inactive VZIG (IND) None 184 Yellow Fever Unspecified Yellow Fever None For MCIR HEDIS query results (not used for MCIR reporting) Antiviral: Osteltamivir 903 (Tamiflu) 904 Antiviral: Anamivir (Relenza) No longer used in MCIR Reporting after March 2011: "Influenza TIV (Historical)" influenza, split (incl. purified 15 None surface antigen) No longer used in MCIR Reporting after 1998 HepA Pediatric (Unspecified, 31 None historical) MCIR does not support electronic submission of H1N1 Influenza Novel Influenza-H1N1-09, Influenza virus vaccine, pandemic 125 Inactive nasal formulation, live, for intranasal use Influenza virus vaccine, pandemic Novel influenza-H1N1-09, 126 Inactive formulation, split-virus, preservative free, preservative-free for intramuscular use Influenza virus vaccine, pandemic 127 Novel influenza-H1N1-09 Inactive formulation, split-virus, for intramuscular use 128 H1N1 Influenza Unspecified Inactive

*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