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Table of Contents

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Rules Based on Patient's Age

  • If a patient is >= 18 years old and has NOT completed the series, then the Recommendation is Conditional and the reason code is HIGH_RISK.2
  • Shots administered to a patient who is >= 18 years of age will continue to be evaluated (based on minimum intervals) and, if valid, will count toward completion of the series.2

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CVX Code

Vaccine Name

Component
CVX Code

Component
Vaccine Name

110

DTaP/HepB/IPV

10

IPV

120

DTaP/IPV/Hib 

10

IPV

130DTaP/IPV10IPV
132DTaP-IPV-Hib-Hep B, historical10IPV
146DTaP, IPV, Hib, Hep B10IPV
170DTaP-IPV-Hib10IPV
195DT-IPV adsorbed Non-US10IPV


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CVX Code Specific Rules

Rule for CVX 178 and CVX 179

  • If a patient receives CVX 178 or CVX 179, evaluate these shots as Invalid with reason code MISSING_ANTIGEN.

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Dose

Series Name

Absolute Minimum
 Age

Minimum Age

Routine
Age 

Latest Recommended Age (less than)Valid CVX Code(s) per Dose for this SeriesInvalid CVX Code(s) per Dose for this Series

1

Polio 4-dose

38 days

42 days (6 weeks)

2 months

3 months + 4 weeks 02, 10, 89, 110, 120, 130, 132, 146, 170, 182, 195
 N/A

2

Polio 4-dose

66 days

70 days (10 weeks)

4 months

5 months + 4 weeks 02, 10, 89, 110, 120, 130, 132, 146, 170, 182, 195
 N/A

3

Polio 4-dose

94 days

98 days (14 weeks)

6 months

19 months + 4 weeks 02, 10, 89, 110, 120, 130, 132, 146, 170, 182, 195
 N/A

4

Polio 4-dose

122 days if dose 4 administered < 8/7/2009

4 years - 4 days if dose 4 administered >= 8/7/2009

126 days if dose 4 administered < 8/7/2009

4 years if dose 4 administered >= 8/7/2009

4 years

7 years + 4 weeks 02, 10, 89, 110, 120, 130, 132, 146, 170, 182, 195
 N/A

Vaccine Dose Parameters - Minimum and Recommended Intervals

Doses

Series Name

Absolute Minimum Interval

Minimum Interval

Minimum Recommended Interval

Latest Recommended Interval (less than)

Dose 1 to 2

Polio 4-dose

24 days

28 days

28 days

15 months + 4 weeks

Dose 2 to 3

Polio 4-dose

24 days

28 days

28 days

13 weeks

Dose 3 to 4

Polio 4-dose

24 days if dose 4 was administered before 8/7/2009

6 months minus 4 days if dose 4 was administered >= 8/7/2009

28 days if dose 4 was administered before 8/7/2009

6 months if dose 4 was administered >= 8/7/2009

6 months

6 years + 4 weeks

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