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These are the rules for the pending ICE release.

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Rules Based on Patient Age

Recommendation Rules

  • If a patient is < 8 months,
    • and is not complete for the RSV Infant Series,
      • and is not in the RSV season as of the evaluation date, 
        • and will be < 8 months at the next RSV season start date, the recommendation is Future Recommended with reason code SUPPLEMENTAL_TEXT, descriptive text, "If the mother of the patient 's mother was not vaccinated during her pregnancy, the mother’s her vaccination status is unknown, or the mother she was vaccinated within 14 days of the patient’s birth: Administer patient birth, then administer RSV mAb dose based on patient weight shortly before or during the RSV season."
        • and will be >= 8 months at the next RSV season start date, the recommendation is Conditional with reason code HIGH_RISK.  
      • and is in the RSV season as of the evaluation date, the recommendation is Recommended with reason code SUPPLEMENTAL_TEXT, descriptive text, "If the mother of the patient 's mother was not vaccinated during her pregnancy, the mother’s her vaccination status is unknown, or the mother she was vaccinated within 14 days of the patient’s birth: Administer patient birth, then administer RSV mAb dose based on patient weight shortly before or during the RSV season." 
    • and is complete for the RSV Infant Series, the recommendation is Not Recommended and the reason code is COMPLETE_HIGH_RISK. 
  • If a patient is >= 8 months and < 20 months, the recommendation is Conditional and the reason code is HIGH_RISK.
  • If a patient is >= 20 months and < 60 years old,
    • and is not complete for the RSV Adult Series, the recommendation is Future Recommended with reason code SUPPLEMENTAL_TEXT with descriptive text,   "The RSV evaluations and recommendations in ICE primarily target the routine series. RSV is recommended as a single lifetime dose for all adults 75 years of age and older and adults 60–74 60 through 74 years of age and older who are at increased risk of severe RSV disease. Note:  RSV RSV vaccine is also recommended for pregnant persons at 32 -through 36 weeks ' gestation, using seasonal administration."
    • and is complete for the RSV Adult Series, the recommendation is Not Recommended with the reason code COMPLETE. 
  • If a patient is >= 60 years old and < 75 years old,
    • and is not complete for the RSV Adult Series, the recommendation is Conditional with reason codes HIGH_RISK and SUPPLEMENTAL_TEXT with descriptive with descriptive text, "The RSV evaluations and recommendations in ICE primarily target the routine series. Adults ages 60- RSV is recommended as a single lifetime dose for all adults 75 years of age and older and adults 60 through 74 years of age who are at increased risk of severe RSV disease receive a single dose of RSV vaccine. RSV vaccination is recommended as a single lifetime dose only. Persons who have already received RSV vaccination are NOT recommended to receive another dose."
    • and is complete for the RSV Adult Series, the recommendation is Not Recommended with the reason code COMPLETE.
  • If a patient is >= 75 years old,
    • and is not complete for the RSV Adult Series, the recommendation is Recommended.
    • and is complete for the RSV Adult Series, the recommendation is Not Recommended with the reason code COMPLETE.
  • The first season of the RSV Infant Series started on 10/1/2023. Therefore, the earliest recommendation date for an RSV dose in the Infant Series is 10/1/2023.
  • The recommended date for the RSV Adult Series is the later of the calculated forecast date or June 26, 2024.

Evaluation of Shots Administered at age >= 8 months and < 50 years

RSV

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If an RSV shot is administered prior to 10/1/2023, evaluate as Invalid with reason code VACCINE_NOT_YET_AVAILABLE_ON_DATE_SPECIFIED.

RSV Vaccines

CVX Code

Name

Absolute Minimum Age

Absolute Maximum Age
303

RSV, recombinant (Adult)



304

Respiratory syncytial virus (RSV), unspecified



305

RSV, bivalent, PF (Adult)



306

RSV, mAb, 0.5 mL, age 0 - < 8 mos.


24 months - 1 day
307

RSV, mAb, 1 mL, age 0 - 19 mos.


24 months - 1 day
314

Respiratory syncytial virus (RSV) vaccine, unspecified



315

Respiratory syncytial virus (RSV) MAB, unspecified


24 months - 1 day

326RSV, mRNA, injectable, PF

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Series Special Rules

Infant RSV Season Rules

  • Infant RSV Season Start and End Dates
    • The infant RSV season default start date is October 1 and the default end date is March 31. The default start date for the next infant RSV season is October 1.
  • Recommendation and Recommended Due Date
    • Infant RSV is due only during the defined RSV season.
      • Note, the earliest date and the recommended date will be when the patient age 0 days to < 8 months is in the infant RSV season. 
  • Evaluation
    • RSV shots1 administered to a patient age < 8 months outside the RSV season (e.g., during September, if the season has been defined as October 1 to March 31) will be evaluated as Valid with reason code OUTSIDE_SEASON. (Note: Patient is complete for the RSV Infant Series.)2 
    • There is no absolute minimum interval between shots administered outside the RSV season and target dose 1 of the next RSV season. 
    • If an RSV shot is administered at age < 8 months, and after the series is complete, then evaluate the shot as Accepted with a reason code of EXTRA_DOSE. 

RSV Infant Series Invalid CVX Code for Dose Rule

  • If CVX codes listed in the "Invalid CVX Code(s) per Dose for this Series" are administered as a target dose in the RSV Infant Series, then the Evaluation is Invalid and the reason code is VACCINE_NOT_ALLOWED_FOR_THIS_DOSE, per the ICE General Rule "Evaluation of Shots Identified as an Invalid CVX Code Per Dose for a Series".  Ignore the shot when determining the recommended vaccine and calculating the recommended due date for the next target dose.

RSV Shots Administered Prior to 8/3/2023

  • If an infant RSV vaccine (CVX 304, CVX 306, CVX 307, CVX 315) is administered prior to 8/3/2023, evaluate the shot as Invalid with reason code VACCINE_NOT_YET_AVAILABLE_ON_DATE_SPECIFIED.


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Notes

  • 1Shots need to be listed as valid CVX codes per dose to be considered Valid.

  • 2Although administration is recommended in the infant RSV season, doses administered outside the season are valid per CDC Guidance and CDSi. 

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Series Special Rules

RSV Adult Series Invalid CVX Code for Dose Rule

  • If CVX codes listed in the "Invalid CVX Code(s) per Dose for this Series" are administered as a target dose in the RSV Adult Series, then the Evaluation is Invalid and the reason code is VACCINE_NOT_ALLOWED_FOR_THIS_DOSE, per the ICE General Rule "Evaluation of Shots Identified as an Invalid CVX Code Per Dose for a Series".  Ignore the shot when determining the recommended vaccine and calculating the recommended due date for the next target dose.

RSV Shots Administered Prior to 6/21/2023

  • If an adult or otherwise unspecified RSV vaccine (CVX 303, CVX 304, CVX 305, CVX 314, CVX 326) is administered prior to 6/21/2023, evaluate the shot as Invalid with reason code VACCINE_NOT_YET_AVAILABLE_ON_DATE_SPECIFIED.


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Notes

  • 3The RSV Adult Series absolute minimum age of 50 years aligns with CDSi and CDC CDSi SME guidance indicating not to repeat a dose given to a patient age >=50 years and < 75 years. 

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