General Evaluation and Recommendation Rules

COVID-19 Vaccine Season Rules

• The 2024-2025 COVID-19 vaccine season start date is 8/22/2024. For the 2024-2025 COVID-19 vaccine season, 
  
  • The recommended date for each series in the 2024-2025 season is 8/22/2024 or later, following series intervals based on patient history.
• The 2023-2024 COVID-19 vaccine season start date is 9/12/2023 and the end date is 8/21/2024. For the 2023-2024 COVID-19 vaccine season,
  •  The recommended date for each series in the 2023-2024 season is 9/12/2023 or later, following series intervals based on patient history.
  • If the patient has >= 1 (invalid) COVID-19 shot(s) administered prior to 9/12/2023, but no doses on record, the intervals from the last shot, if prior to 9/12/2023, are: 
    • Absolute Minimum Interval = 8 weeks - 4 days
    • Minimum Interval = 8 weeks  
    • Recommended Interval = 8 weeks  
• The pre-September 2023 COVID-19 vaccine season end date is 9/11/2023. For the pre-September 2023 COVID-19 vaccine season,
  • Shots administered prior to 9/12/2023 are evaluated according to the logic specified on COVID-19 Vaccine Group - Prior to September 12, 2023, with the following exceptions:
    • If a CVX 308, CVX 309, CVX 310, CVX 311, or CVX 312 is administered prior to 9/12/2023, evaluate as Invalid with reason code VACCINE_NOT_YET_AVAILABLE_ON_DATE_SPECIFIED.
    • If a CVX 313 is administered prior to 10/4/2023, evaluate as Invalid with reason code VACCINE_NOT_YET_AVAILABLE_ON_DATE_SPECIFIED.
• For all COVID-19 vaccine seasons, 
  • COVID-19 shots administered are evaluated based on the rules in effect as of the shot administration date.
  • COVID-19 recommendations are based on the rules in effect as of the evaluation date. 

• Starting with the 2023-2024 COVID-19 vaccine season, if the patient has no COVID-19 shots on record, recommend at 6 months of age or at the season start date when the patient is >= 6 months of age, whichever date is later.

Prior Formulation and Vaccines Not Counting Towards U.S. Vaccination Administered on or after 9/12/2023  

• If a prior formulation of a COVID-19 vaccine, excluding CVX 211, is administered on or after 9/12/2023, evaluate as Invalid with reason code VACCINE_NOT_ALLOWED.¹
• If the patient has a prior formulation that does not count towards U.S. vaccination (CVX 500, CVX 501, CVX 503, CVX 504, CVX 505, CVX 506, CVX 507, CVX 508, CVX 509, CVX 513, CVX 514, CVX 515, CVX 516, CVX 517, CVX 518, CVX 521) administered on or after 9/12/2023, evaluate as Invalid with reason code VACCINE_NOT_ALLOWED.¹ Intervals to the next target dose are: 
  • Absolute Minimum Interval = 8 weeks - 4 days
  • Minimum Interval = 8 weeks
  • Recommended Interval = 8 weeks 
• If the prior formulation of Novavax (CVX 211) is administered on or after 10/4/2023, evaluate as Invalid with reason code is VACCINE_NOT_ALLOWED.¹

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

• When recommending in the Seasonal COVID-19 Series (>= 5 years), the Seasonal Mixed Product COVID-19 Series (< 5 years), or the Seasonal Novavax COVID-19 Series, recommend at the vaccine group level. 
• When recommending in the Seasonal COVID-19 Pfizer Series (< 5 years) or the Seasonal COVID-19 Moderna Series (< 5 years), recommend at the CVX code level and recommend the vaccine product applicable for the series and the patient's age, based on the COVID-19 Vaccines table, unless the following exception applies:
  • If the patient is >= 5 years as of the recommended date or the evaluation date, and either the recommendation date or the evaluation date is >= 8 weeks from the last administered COVID-19 shot, recommend at the vaccine group level.

Notes

• ¹ Note: If applicable, evaluation reason codes in addition to VACCINE_NOT_ALLOWED will also be returned.

Notes

• Updated seasonal COVID-19 vaccines include the following CVX codes: CVX 308, CVX 309, CVX 310, CVX 311, CVX 312, and CVX 313.
• Prior formulations of COVID-19 vaccines include the following CVX codes: CVX 207, CVX 208, CVX 210, CVX 211, CVX 212, CVX 213, CVX 217, CVX 218, CVX 219, CVX 221, CVX 227, CVX 228, CVX 229, CVX 230, CVX 300, CVX 301, CVX 302, CVX 500, CVX 501, CVX 502, CVX 503, CVX 504, CVX 505, CVX 506, CVX 507, CVX 508, CVX 509, CVX 510, CVX 511, CVX 512, CVX 513, CVX 514, CVX 515, CVX 516, CVX 517, CVX 518, CVX 519, CVX 520, and CVX 521. 
  • Prior formulations of COVID-19 vaccines that may have been Valid prior to 9/12/2023 include: CVX 207, CVX 208, CVX 210, CVX 211, CVX 212, CVX 213, CVX 217, CVX 218, CVX 219, CVX 221, CVX 227, CVX 228, CVX 229, CVX 230, CVX 300, CVX 301, CVX 302, CVX 502, CVX 510, CVX 511, CVX 512, CVX 519, and CVX 520.
  • Prior formulations of COVID-19 vaccines that do not count towards U.S. vaccination include: CVX 500, CVX 501, CVX 503, CVX 504, CVX 505, CVX 506, CVX 507, CVX 508, CVX 509, CVX 513, CVX 514, CVX 515, CVX 516, CVX 517, CVX 518, and CVX 521.
• For the table of COVID-19 vaccines prior to September 12, 2023, please see COVID-19 Vaccine Group - Prior to September 12, 2023. 

CVX Code Specific Rules

CVX Code Absolute Minimum Age

• If one of the CVX codes in the table above is administered below the absolute minimum age for that CVX code, then the Evaluation is Invalid and the reason code is BELOW_MINIMUM_AGE_VACCINE, per the ICE General Rule "Evaluation of Shots Below the Vaccine Code Absolute Minimum Age."

CVX Code Absolute Maximum Age

• If one of the CVX codes in the table above is administered above the absolute maximum age for that CVX code, then the Evaluation is Invalid and the reason code is ABOVE_MAXIMUM_AGE_VACCINE, per the ICE General Rule "Evaluation of Shots Above the Vaccine Code Absolute Maximum Age."

  • There is no interval required between the Invalid shot and the next target dose. 

Series Name

• Seasonal COVID-19 Series (>= 5 years)
• Seasonal Pfizer COVID-19 Series  (< 5 years)

• Seasonal Moderna COVID-19 Series  (< 5 years)

• Seasonal Mixed Product COVID-19 Series (< 5 years)

• Seasonal Novavax COVID-19 Series

Series Selection Rules

The rules for determining which series applies are: 

• To determine if a < 5 years series applies: 
  • If: 
    • the patient is < 5 years of age as of the evaluation date,
    • OR
    • the patient is >= 5 years of age as of the evaluation date and one of the following is true:
      • if there is a shot administered in the current season at < 5 years of age,
      • or in a prior season >= 1 dose was administered at < 5 years of age and the < 5 year primary series is not complete,
  • Then a < 5 years series applies. The rules for determining the < 5 year series are as follows: 
    • if all the doses on record (if any) are a Moderna vaccine (CVX 207, CVX 221, CVX 227, CVX 228, CVX 229, CVX 230, CVX 311, CVX 312, CVX 519), then the Seasonal Moderna COVID-19 Series (< 5 years) applies.
    • if all the doses on record (if any) are a Pfizer vaccine (CVX 208, CVX 217, CVX 218, CVX 219, CVX 300, CVX 301, CVX 302, CVX 308, CVX 309, CVX 310, CVX 520), then the Seasonal Pfizer COVID-19 Series (< 5 years) applies.
    • if neither of the above two conditions is true, then the Seasonal Mixed Product COVID-19 Series (< 5 years) applies.

• If the above is not true (I.e., a < 5 years series does not apply), to determine if the Novavax or >= 5 years series applies:    
  
  • if the patient has no prior COVID-19 doses on record before the season start date and  
    
    • dose 1 in a seasonal series is Novavax (CVX 211, CVX 313),
      • and there are no other doses after dose 1 (in a seasonal series),
        • and dose 1 was administered at >= 12 years - 4 days, then the Seasonal Novavax Series applies. 
        • and dose 1 was administered at < 12 years - 4 days, then the Seasonal COVID-19 Series (>= 5 years) applies.
      • and dose 2 (in a seasonal series) is Novavax (CVX 211, CVX 313), then the Seasonal Novavax Series applies.
    • dose 1 in seasonal series is not Novavax (CVX 211, CVX 313), then the Seasonal COVID-19 Series (>= 5 years) applies. 
  • if the above condition is not true, then the Seasonal COVID-19 Series (>= 5 years) applies.

• If a series selected via one of the above conditions is not complete but another series is complete, select the complete series.
• If a series selected via one of the above conditions is complete but another series is also complete at an earlier date, select the series that completed at the earlier date.

Series Special Rules

Shots Administered Below Series Absolute Minimum Age 

• If a shot is administered below the series absolute minimum age (< 6m - 4 days), evaluate as Invalid with reason code BELOW_MINIMUM_AGE_SERIES per the ICE General Rule "Evaluation of Shots Below the Series Absolute Minimum Age".
  • If administered as target dose 1 or target dose 2, intervals to the next target dose are:  
    • Absolute minimum interval = 24 days
    • Minimum interval = 28 days
    • Recommended interval = 28 days 
  • If administered as target dose 3, follow series intervals.

CVX Code Absolute Maximum Age

• For the 2023-2024 COVID-19 vaccine season, there is no absolute maximum age for CVX 308 for doses 2 and 3.

Skip Dose Rules 

• Target Dose 1
  • If the patient has 1 dose of any of the following Pfizer COVID-19 vaccines (CVX 208, CVX 217, CVX 218, CVX 219, CVX 300, CVX 301, CVX 302, CVX 308, CVX 309, CVX 310, or CVX 520) administered prior to the season start date, target dose 1 is not needed. Skip to target dose 2.
    • Absolute minimum interval = 17 days 
    • Minimum interval = 21 days
    • Recommended interval = 21 days
    • Latest recommended interval (less than) = N/A
• Target Dose 1 and Target Dose 2
  • If the patient has >= 2 doses of any of the following Pfizer COVID-19 vaccines (CVX 208, CVX 217, CVX 218, CVX 219, CVX 300, CVX 301, CVX 302, CVX 308, CVX 309, CVX 310, CVX 520) administered prior to the season start date, target dose 1 and target dose 2 are not needed. Skip to target dose 3.
    • Absolute minimum interval = 8 weeks - 4 days
    • Minimum interval = 8 weeks
    • Recommended interval = 8 weeks
    • Latest recommended interval (less than) = N/A

Interval from a Prior Formulation or Non-Pfizer Vaccine Administered on or after 9/12/2023

• If a prior formulation COVID-19 vaccine (excluding COVID-19 vaccines that do not count towards U.S. vaccination2) or a non-Pfizer updated seasonal COVID-19 vaccine (CVX 213, CVX 311, CVX 312, CVX 313) is administered as target dose 1 or target dose 2 on or after 9/12/2023, intervals to the next target dose are: 
  • Absolute minimum interval = 24 days 
  • Minimum interval = 28 days
  • Recommended interval = 28 days

Series Completion Rule

• If the patient has 1 dose of CVX 309 or CVX 310 at age >= 5 years, then the series is complete. 

Notes

• ² COVID-19 shots that do not count towards U.S. vaccination include: CVX 500, CVX 501, CVX 503, CVX 504, CVX 505, CVX 506, CVX 507, CVX 508, CVX 509, CVX 513, CVX 514, CVX 515, CVX 516, CVX 517, CVX 518, and CVX 521. 

Series Special Rules

Shots Administered Below Series Absolute Minimum Age 

• If a shot is administered below the series absolute minimum age (< 6m - 4 days), evaluate as Invalid, with reason code BELOW_MINIMUM_AGE_SERIES per the ICE General Rule "Evaluation of Shots Below the Series Absolute Minimum Age". Intervals to the next target dose are:
  
  • Absolute minimum interval = 24 days
  • Minimum interval = 28 days
  • Recommended interval = 28 days 

Skip Dose Rules 

• Target Dose 1
  • If the patient has 1 dose of any of the following Moderna COVID-19 vaccines (CVX 207, CVX 221, CVX 227, CVX 228, CVX 229, CVX 230, CVX 311, CVX 312, or CVX 519) administered prior to the season start date, target dose 1 is not needed. Skip to target dose 2. 
    • Absolute minimum interval = 24 days
    • Minimum interval = 28 days
    • Recommended interval = 28 days
    • Latest recommended interval (less than) = N/A 
  • If the patient has >= 2 doses of any of the following Moderna COVID-19 vaccines (CVX 207, CVX 221, CVX 227, CVX 228, CVX 229, CVX 230, CVX 311, CVX 312, CVX 519) administered prior to the season start date, target dose 1 is not needed. Skip to target dose 2. 
    
    • Absolute minimum interval = 8 weeks - 4 days
    • Minimum interval = 8 weeks 
    • Recommended interval = 8 weeks 

Interval from a Prior Formulation or Non-Moderna Vaccine Administered on or after 9/12/2023

• If a prior formulation COVID-19 vaccine (excluding vaccines that do not count towards U.S. vaccination³) or a non-Moderna updated seasonal COVID-19 vaccine (CVX 213, CVX 308, CVX 309, CVX 310, CVX 313) is administered as target dose 1 or target dose 2 on or after 9/12/2023, intervals specified in the series table apply. 

Notes

• ³ COVID-19 shots that do not count towards U.S. vaccination include: CVX 500, CVX 501, CVX 503, CVX 504, CVX 505, CVX 506, CVX 507, CVX 508, CVX 509, CVX 513, CVX 514, CVX 515, CVX 516, CVX 517, CVX 518, and CVX 521. 

Series Special Rules

Shots Administered Below Series Absolute Minimum Age 

• If a shot is administered below the series absolute minimum age (< 6m - 4 days), evaluate as Invalid with reason code BELOW_MINIMUM_AGE_SERIES per the ICE General Rule "Evaluation of Shots Below the Series Absolute Minimum Age".
  • If administered as target dose 1 or target dose 2, intervals to the next target dose are:  
    • Absolute minimum interval = 24 days
    • Minimum interval = 28 days
    • Recommended interval = 28 days 
  • If administered as target dose 3, follow series intervals.

CVX Code Absolute Maximum Age

• For the 2023-2024 COVID-19 vaccine season, there is no absolute maximum age for CVX 308 for doses 2 and 3.

Skip Dose Rules 

• Target Dose 1 
  • If the patient has 1 dose of COVID-19 vaccine (CVX 207, CVX 208, CVX 210, CVX 211, CVX 212, CVX 213, CVX 217, CVX 218, CVX 219, CVX 221, CVX 227, CVX 228, CVX 229, CVX 230, CVX 300, CVX 301, CVX 302, CVX 308, CVX 309, CVX 310, CVX 311, CVX 312, CVX 502, CVX 510, CVX 511, CVX 519, or CVX 520) administered prior to the season start date, target dose 1 is not needed. Skip to target dose 2.
    
    • Absolute minimum interval = 24 days
    • Minimum interval = 28 days
    • Recommended interval = 28 days
    • Latest recommended interval (less than) = N/A

• Target Dose 1 and Target Dose 2
  • If the patient has >= 2 doses of COVID-19 vaccine (CVX 207, CVX 208, CVX 210, CVX 211, CVX 212, CVX 213, CVX 217, CVX 218, CVX 219, CVX 221, CVX 227, CVX 228, CVX 229, CVX 230, CVX 300, CVX 301, CVX 302, CVX 308, CVX 309, CVX 310, CVX 311, CVX 312, CVX 502, CVX 510, CVX 511, CVX 519, or CVX 520) administered prior to the season start date, target dose 1 and target dose 2 are not needed. Skip to target dose 3.
    
    • Absolute minimum interval = 8 weeks - 4 days
    • Minimum interval = 8 weeks
    • Recommended interval = 8 weeks
    • Latest recommended interval (less than) = N/A

Novavax Administered to a Patient Age >= 6 months - 4 days and < 5 Years

• If CVX 313 was the most recent shot administered to a patient age >= 6 months - 4 days and < 5 years and the series is not complete, return recommended reason code ADMINISTER_mRNA_VACCINE. 

Interval from a Prior Formulation or Invalid Updated Seasonal Vaccine Administered on or after 9/12/2023

• If a prior formulation COVID-19 vaccine (excluding vaccines that do not count towards U.S. vaccination⁴) or other invalid updated seasonal COVID-19 vaccine is administered as target dose 1 or target dose 2 on or after 9/12/2023, intervals specified in the series table apply. 

Series Completion Rules 

• If the patient has 1 dose of CVX 309, CVX 310, CVX 311, or CVX 312 at age >= 5 years, then the series is complete. 
• If the patient has >= 1 dose of COVID-19 vaccine at age < 5 years and has 1 dose of CVX 313 at age >= 5 years, then the series is complete.
• If the patient has 2 doses of CVX 313, the series is complete. 

Notes

• ⁴ COVID-19 shots that do not count towards U.S. vaccination include: CVX 500, CVX 501, CVX 503, CVX 504, CVX 505, CVX 506, CVX 507, CVX 508, CVX 509, CVX 513, CVX 514, CVX 515, CVX 516, CVX 517, CVX 518, and CVX 521. 

Notes

• ⁵ Target dose 3 is applicable for patients with two doses of CVX 211 administered between 9/12/2023 and 10/3/2023.

Series Special Rules

Novavax Administered to a Patient Age >= 5 years and < 12 years - 4 days

• If a dose of CVX 313 is administered between age >= 5 years and < 12 years - 4 days, and the patient has no other valid doses on record, then the following evaluation and recommendation parameters apply:
  
  • Absolute Minimum Interval = 17 days 
  • Minimum Age = 5 years  
  • Minimum Interval = 28 days 
  • Recommended Interval = 28 days. If the patient is < 12 years as of the evaluation date and is < 12 years at the recommended due date), return recommended reason code ADMINISTER_mRNA_VACCINE. 

mRNA Administered for Target Dose 2

• If a CVX 213, CVX 309, or CVX 312 is administered for target dose 2, and target dose 2 is administered < 8 weeks - 4 days from dose 1, evaluate as Invalid / Below Minimum Interval.

Skip Dose Rules 

• For target dose 3, if CVX 313 was administered for dose 1 or dose 2, dose 3 is not needed. Skip to target dose 4. Use the absolute minimum interval, minimum interval, recommended interval, and latest recommended interval for dose 3 to dose 4. 

Target Dose 4

• For target dose 4,
  • If the target dose 4 recommendation date is >= 1 year from the evaluation date, the recommendation is Not Recommended and the reason code is COMPLETE.
  • For the 2023-2024 season, the recommended date is the later of the calculated forecast date or February 28, 2024.
  • If a shot listed as a "Valid CVX Code(s) per Dose for this Series" is administered before the absolute minimum age for target dose 4 (i.e., 65 years - 4 days), evaluate as Accepted with reason code OUTSIDE_ROUTINE_SERIES. 
  • If a CVX 310 or CVX 311 is administered below the absolute minimum age for target dose 4 and <= the CVX code absolute maximum age, evaluate as Accepted with reason code OUTSIDE_ROUTINE_SERIES.