Rules Based on Patient's Age

• If a patient is < 27 years old, follow the Immunization Series and Selection Rules (listed below).

• If a patient is >= 27 years and < 46 years old and:

  • Has one or more doses at < 46 years old, has not completed the series, and will be < 46 years old at the next recommended due date, then recommend based on table rules. 

  • Does NOT have any doses at < 46 years old, then Recommendation is Conditional with reason codes CLINICAL_PATIENT_DISCRETION and SUPPLEMENTAL_TEXT, with descriptive text, "HPV is not routinely recommended for all patients aged 27 through 45 years. Use Shared Clinical Decision-Making to identify individuals who may benefit."

  • Shots administered to a patient who is >= 27 years and < 46 years will continue to be evaluated (based on absolute minimum intervals) and, if valid, will count toward completion of the series.

• If the patient is >= 46 years old, (or will be >= 46 years old at the next recommended due date), then:

  • Recommendation is Not Recommended and the reason code is TOO_OLD. 

  • If a dose is administered at >= 46 years, the Evaluation is Accepted and the reason code is ABOVE_REC_AGE_SERIES.

  • The series can NOT be initiated and completed once the patient is >= 46 years old.

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

• When recommending in the HPV 3-dose series or HPV 2-dose series, always recommend at the vaccine group level.

CVX Code Specific Rules

Rule for CVX 118 (HPV, bivalent (Cervarix)

• CVX 118 is not licensed for use in males. If CVX 118 (HPV, bivalent (Cervarix) is reported for a male patient, then evaluate as Accepted and the reason code is VACCINE_NOT_LICENSED_FOR_MALES. Ignore the reported CVX 118 when determining the recommended vaccine and calculating the recommended due date for the next target dose.

Series Name

• HPV 2-dose Series

• HPV 3-dose Series

Series Selection Rules

The HPV 2-dose series applies if any one of the following is true:

• If the patient < 15 years old and no doses have been administered

• If dose 1 was administered and is given to a patient >= 9 years - 4 days old and < 15 years old

• If dose 1 was administered and is given to a patient >= 9 years - 4 days old and < 15 years old and

  • target dose 2 is valid for the HPV 2-dose series, the HPV 2-dose series applies.

  • target dose 2 is invalid or accepted for the HPV 2-dose series, but valid for HPV 3-dose series, the HPV 3-dose series applies. (Note: Once the 3-dose series is triggered, it cannot switch back to applying the 2-dose series.)

  • target dose 2 is invalid or accepted for BOTH the HPV 2-dose series and HPV 3-dose series, the HPV 2-dose series applies.

Otherwise, the HPV 3-dose series applies.

Series Special Rules 

If target dose 2 is invalid, the following intervals to target dose 2 apply:

• From (the most recent) invalid target dose 2 to target dose 2:

  • Absolute minimum interval: 12 weeks - 4 days

  • Minimum interval: 12 weeks

  • Recommended interval: 12 weeks

• From dose 1 to target dose 2, the table rules apply.