Rules Based on Patient's Age

• If a patient is >= 60 years old and did NOT get a shot of Hep B, then the Recommendation is Conditional and the reason code is HIGH_RISK. 

• Shots administered to a patient who is >= 60 years of age will continue to be evaluated and, if valid, will count toward completion of the series.

Proof of Immunity Rules

• If a patient has immunity (reported as having a positive titer or serology) vaccine is not recommended; Recommendation is Not Recommended and the reason code is PROOF_OF_IMMUNITY.

• Any shot administered prior to the date of immunity is evaluated as Valid or Invalid, based on minimum age and minimum interval rules.

• Any shot administered on or after the date of immunity is evaluated as Accepted with a reason code of PROOF_OF_IMMUNITY unless the series is COMPLETE.

Select Adjuvant Product Interval

• The Select Adjuvant Product Interval rule applies to CVX 189. For rule details, see the Select Adjuvant Product Interval rule on the General Rules page.

Rules for Recommending at the CVX Code vs. Vaccine Group Level

• When recommending in the Hep B 3-dose Child/Adolescent Series, Hep B 4-dose Child/Adolescent Series, or the Hep B 3-dose Adult Series, recommend at the vaccine group level.

• When recommending in the Hep B 2-dose Adult Series, recommend at the CVX level; vaccine recommended should be CVX 189 (Hep B, adjuvanted).

• When recommending in the Hep B 3-dose Twinrix Series, recommend at the CVX level; vaccine recommended should be CVX 104 (Hep A-Hep B (Twinrix)) along with supplemental text: "If the Twinrix vaccine (CVX 104) is not available, another adult Hep B vaccine may be administered."

• When recommending in the Hep B 4-dose Accelerated Twinrix Series, recommend at the CVX level; vaccine recommended should be CVX 104 (Hep A-Hep B (Twinrix)).

CVX Code Specific Rules

CVX Code Maximum Age

• CVX 08 (Hep B, adolescent or pediatric) and CVX 42 (Hep B, adolescent/high risk infant) will be evaluated as follows:

  • Invalid / INSUFFICIENT_ANTIGEN if administered to a patient who is >= 20 years old.

  • Valid (as long as minimum interval/minimum age requirements are met, where applicable) if administered to a patient who is < 20 years old.

Series Name

• Hep B 3-dose Child/Adolescent Series

• Hep B 4-dose Child/Adolescent Series

• Hep B 2-dose Adult Series

• Hep B 3-dose Adult Series

• Hep B 3-dose Twinrix Series

• Hep B 4-dose Accelerated Twinrix Series

Series Selection Rules

Note: To accommodate Twinrix series selections in Hep A and Hep B, the series selection logic in Hep B will be run before the Hep A series selection logic.

If the Hep B 3-dose Child/Adolescent series was previously switched to the Hep B 4-dose Child/Adolescent Series, then replace "Hep B 3-dose Child/Adolescent Series" with "Hep B 4-dose Child/Adolescent Series".

Additionally, the logic is ordered; the selection rules must run in the order presented on this page.

Rules for Determining When to Apply the 3-dose Child/Adolescent Series vs. Adult 2-Dose Series vs. Adult 3-Dose Series vs. Hep B 3-Dose Twinrix Series vs. Hep B 4-Dose Accelerated Twinrix Series

• If the patient is >= 18 years - 4 days old and dose 1 is CVX 104:

  • if dose 1 is CVX 104 for both Hep A and Hep B, and there are no other Hep B doses on record, then the Hep B 3-dose Twinrix Series applies.

    • However, if upon completion of the Hep A series selection logic, the Hep A 3-Dose Series was not selected for the Hep A vaccine group, then undo this selection of the Hep B 3-dose Twinrix Series and continue with the series selection logic below to select a different Hep B series.

  • if dose 1 and dose 2 are CVX 104 for both Hep A 4-dose Accelerated Twinrix Series and Hep B 4-dose Accelerated Twinrix Series, there are two or more doses administered, dose 2 administered >= 7 days and < 24 days from dose 1 for both Hep A 4-dose Accelerated Twinrix Series and Hep B 4-dose Accelerated Twinrix Series, and there are no doses of Hep A that were administered prior to dose 1 of the Hep B vaccine group, then the Hep B 4-dose Accelerated Twinrix Series applies.

    • if dose 1 was administered at < 19 years of age:

      • and there are 3 valid doses in the Hep B 3-dose Child/Adolescent Series, but < 4 valid doses in the Hep B 4-dose Accelerated Twinrix Series, then unselect the Hep B 4-dose Accelerated Twinrix Series and select Hep B 3-dose Child/Adolescent Series.

      • and there is a dose administered in the Hep B 3-dose Child/Adolescent Series where the administration date is after the latest dose in the Hep B 4-dose Accelerated Twinrix Series, and the Hep B 3-dose Child/Adolescent Series has fewer doses remaining to complete the series than the Hep B 4-dose Accelerated Twinrix Series, then select Hep B 3-dose Child/Adolescent Series.

      • If a previously administered (Valid) dose in the Hep B 4-dose Accelerated Twinrix Series is Invalid in the Hep B 3-dose Child/Adolescent Series, change the evaluation to Accepted / VACCINE_NOT_COUNTED_BASED_ON_MOST_RECENT_VACCINE_GIVEN.

    • if dose 1 was administered >= 19 years of age:

      • and there are 3 valid doses in the Hep B 3-dose Adult Series, but < 4 valid doses in the Hep B 4-dose Accelerated Twinrix Series, then unselect the Hep B 4-dose Accelerated Twinrix Series and select Hep B 3-dose Adult Series.

      • and there is a dose administered in the Hep B 3-dose Adult Series after the latest dose in the Hep B 4-dose Accelerated Twinrix Series and the Hep B 3-dose Adult Series have fewer doses remaining to complete the series than the Hep B 4-dose Accelerated Twinrix Series, then select Hep B 3-dose Adult Series.

      • If a previously administered (Valid) dose in the Hep B 4-dose Accelerated Twinrix Series is Invalid in the Hep B 3-dose Adult Series, change the evaluation to Accepted / VACCINE_NOT_COUNTED_BASED_ON_MOST_RECENT_VACCINE_GIVEN.

    • However, if upon completion of the Hep A series selection logic, the Hep A 4-Dose Twinrix Series was not selected for the Hep A vaccine group, then undo the selection of this Hep B 4-dose Twinrix Series and continue with the series selection logic below to select a different Hep B series.

  • if dose 1 and dose 2 are CVX 104 for both Hep A and Hep B, there is no series other than the Hep B 3-dose Twinrix Series that is complete, there are two or more doses administered, and dose 2 was administered >= 24 days from dose 1, there are no prior Hep B doses on record, and the Hep B doses are in the Hep B 3-dose Twinrix Series and Hep A 3-dose Series, then the Hep B 3-dose Twinrix Series applies.

    • However, if upon completion of the Hep A series selection logic, the Hep A 3-Dose Series was not selected for the Hep A vaccine group, then undo the selection of the Hep B 3-dose Twinrix Series and continue with the series selection logic below to select a different Hep B series.

• If the patient is >= 18 years - 4 days and dose 1 is CVX 189:

  • if dose 1 was administered at < 19 years of age: 

    • and there are no other doses on record, series = Hep B 2-dose Adult Series. 

    • and target dose 2 is invalid or accepted for the 2-dose Adult Series or 3-dose Child/Adolescent Series, series = Hep B 2-dose Adult Series.

    • and target dose 2 is valid for the 2-dose Adult Series, series = Hep B 2-dose Adult Series.

    • and there are >= 2 valid shots in the 3-dose Child/Adolescent Series, but < 2 valid shots in the 2-dose Adult Series, series = Hep B 3-dose Child/Adolescent Series.

    • and there are 3 valid shots in the 3-dose Child/Adolescent Series and 2 valid shots in the 2-dose Adult Series and both series are completed on the same day, series = Hep B 3-dose Child/Adolescent Series.

  • if dose 1 was administered >= 19 years of age:

    • and there are no other doses on record, series = Hep B 2-dose Adult Series.

    • and target dose 2 is invalid or accepted for the 2-dose Adult series or 3-dose Adult series series = Hep B 2-dose Adult Series.

    • and target dose 2 is valid for the 2-dose Adult Series, series = Hep B 2-dose Adult Series.

    • and there are >= 2 valid shots in the 3-dose Adult Series, but < 2 valid shots in the 2-dose Adult Series, series = Hep B 3-dose Adult Series.

    • and there are 3 valid shots in the 3-dose Adult Series and 2 valid shots in the 2-dose Adult Series and both series are completed on the same day, series = Hep B 3-dose Adult Series.

• If the patient is < 19 years old and has not received the first shot of Hep B, series = Hep B 3-dose Child/Adolescent Series.

• If the patient is < 19 years old when they receive the first shot of Hep B, series = Hep B 3-dose Child/Adolescent Series.

• If the patient is >= 19 years old and < 60 years old and has not received the first shot of Hep B, series = Hep B 3-dose Adult Series.

• If the patient is >= 19 years old when they receive the first dose of Hep B and dose 1 is not CVX 189, series = Hep B 3-dose Adult Series. 

• If the patient is >= 60 years old and receives an invalid shot for Target Dose 1, series = Hep B 3-dose Adult Series. 

Notes

• If there are 3 valid doses in the Hep B 3-dose Child/Adolescent Series and 4 valid doses in the Hep B 4-dose Accelerated Twinrix Series, and both series are completed on the same day, series = Hep B 4-dose Accelerated Twinrix Series.

• If there are 3 valid doses in the Hep B 3-dose Adult Series and 4 valid doses in the Hep B 4-dose Accelerated Twinrix Series, and both series are completed on the same day, series = Hep B 4-dose Accelerated Twinrix Series.

Series Special Rules 

HEPLISAV-B (CVX 189) Exception Rule

• A series containing 2 doses of HEPLISAV-B (CVX 189) administered at least minimum interval 4 weeks (absolute minimum interval = 24 days) apart is complete, regardless of any other Hep B shots administered (before, in between). For the non-CVX 189 shots, evaluate as Accepted and the reason code is VACCINE_NOT_COUNTED_BASED_ON_MOST_RECENT_VACCINE_GIVEN. For the purpose of evaluation of the non-CVX 189 administered vaccines, ignore the non-CVX 189 shots. 

  • Note: All shots given after a series is complete should be evaluated according to the ICE General Rule "Shots Administered After Series is Complete".

Adolescent Rules: Series Complete After 2 Doses

• If a.) CVX 43 (Hep B adult) is administered to a patient >= 11 years and < 16 years as dose 1 and dose 2 AND b.) there is a minimum interval of 4 months - 4 days between dose 1 and dose 2, THEN the series is complete with 2 doses. If this rule is not met, default to the Hep B 3-dose Child/Adolescent Series.

• If a patient >= 11 years and < 16 years is administered CVX 43 (Hep B adult) as shot 1, shot 2 will be recommended based on the Hep B 3-dose Child/Adolescent Series, NOT as complete via the Adolescents Rules: Series Complete After 2 Doses.

Switch to Hep B 4-dose Child/Adolescent Series if Target Dose 3 Does Not Meet Absolute Minimum Interval or Series Absolute Minimum Age

• If target dose 3 in the Hep B 3-dose Child/Adolescent Series is invalid only due to an absolute minimum interval or series absolute minimum age violation, then switch to the Hep B 4-dose Child/Adolescent Series starting at target dose 3.

  • Note: This rule does not apply for any other invalid or accepted evaluation reasons (e.g. CVX 189, 220 given < 18 years - 4 days).

Series Special Rules 

Note: Based on the table, dose 3 is ignored for purposes of evaluation and recommendation and subsequent invalid shots are ignored for purposes of recommendation to dose 4.

HEPLISAV-B (CVX 189) Exception Rule

• A series containing 2 doses of HEPLISAV-B (CVX 189) administered at least minimum interval 4 weeks (absolute minimum interval = 24 days) apart is complete, regardless of any other Hep B shots administered (before, in between). For the non-CVX 189 shots, evaluate as Accepted and the reason code is VACCINE_NOT_COUNTED_BASED_ON_MOST_RECENT_VACCINE_GIVEN. For the purpose of evaluation of the non-CVX 189 administered vaccines, ignore the non-CVX 189 shots. 

  • Note: All shots given after a series is complete should be evaluated according to the ICE General Rule "Shots Administered After Series is Complete".