General Evaluation and Recommendation Rules

COVID-19 Vaccine Season Rules

• 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.

2025-2026 Season Rules

• The 2025-2026 COVID-19 vaccine season start date is 8/27/2025. For the 2025-2026 COVID-19 vaccine season,

  • The recommended date for each of the series is 8/27/2025 or later, following series intervals based on patient history.

  • If the patient is complete for the season, the recommendation is Not Recommended / COMPLETE_HIGH_RISK.

2023-2024 and 2024-2025 Season Rules

• 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 2024-2025 COVID-19 vaccine season start date is 8/22/2024 and the end date is 8/26/2025. 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.

• For the 2023-2024 and 2024-2025 COVID-19 vaccine seasons, if a CVX 213 and CVX 313 are administered on the same day and both CVX codes would otherwise be considered valid, evaluate the CVX 213 as Valid and evaluate the CVX 313 as Invalid / DUPLICATE_SAME_DAY. 

Pandemic COVID-19 Rules

• 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 COVID-19 Pandemic Vaccine Group logic.

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.

• 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.

  • For the 2023-2024 and 2024-2025 season, intervals to the next target dose are: 

    • Absolute Minimum Interval = 8 weeks - 4 days

    • Minimum Interval = 8 weeks

    • Recommended Interval = 8 weeks 

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

2025-2026 Season 

• When recommending in the Seasonal 1-dose COVID-19 Series (2 - 64 years) or the Seasonal 2-dose COVID-19 Series (>= 65 years), recommend at the vaccine group level.

• When recommending in the Seasonal 2-dose COVID-19 Series  (< 2 years), recommend CVX 311. 

2023-2024 and 2024-2025 Season

• 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.

CVX Code Specific Rules

CVX Code Administered Above Absolute Maximum Age

• If a shot is evaluated as Invalid / ABOVE_MAXIMUM_AGE_VACCINE (i.e., due to the Evaluation of Shots Above the Vaccine Code Absolute Maximum Age ICE General Rule), the following intervals apply:

  • Absolute minimum interval = 0 days

  • Minimum interval = 0 days

  • Recommended interval = 0 days

Notes

• See the ICE General Rules:   

  • Evaluation of Shots Below the Vaccine Code Absolute Minimum Age

  • Evaluation of Shots Above the Vaccine Code Absolute Maximum Age

  • Evaluation of Shots Prior to the Vaccine Code Start Date

  • Evaluation of Shots After the Vaccine Code End Date

• For the COVID-19 vaccines prior to September 12, 2023, please see COVID-19 Pandemic Vaccine Group. 

• 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.

Series Name

2025-2026 Season

• Seasonal 2-dose COVID-19 Series (< 2 years) 

• Seasonal 1-dose COVID-19 Series (2 - 64 years) 

• Seasonal 2-dose COVID-19 Series (>= 65 years)

2023-2024 and 2024-2025 Season

• 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

2025-2026 Season

• If the patient is < 2 years of age as of the evaluation date, or the patient is >= 2 years of age as of the evaluation date and if there is a shot administered in the current season at < 2 years of age, then the Seasonal 2-dose COVID-19 Series (< 2 years) applies.

• If the above is not true, to determine which >= 2 year series applies, 

  • If the patient has no in-season shots on record,

    • and the patient is >= 2 years and < 65 years as of evaluation date, then the Seasonal 1-dose COVID-19 Series (2 - 64 years) applies.

    • and the patient is >= 65 years as of evaluation date, then the Seasonal 2-dose COVID-19 Series (>= 65 years)

  • If the patient received target dose 1 at age >= 2 years and < 65 years, then the Seasonal 1-dose COVID-19 Series (2 - 64 years) applies

    • If the series was switched from the Seasonal 1-dose COVID-19 Series (2-64 years) to the Seasonal 2-dose COVID-19 Series (>= 65 years), select the Seasonal 2-dose COVID-19 Series (>= 65 years).

  • If the patient received target dose 1 at age >= 65 years, then the Seasonal 2-dose COVID-19 Series (>= 65 years) 

2023-2024 and 2024-2025 Season

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". Intervals to the next target dose are:

  • Absolute minimum interval = 24 days

  • Minimum interval = 28 days

  • Recommended interval = 28 days 

Interval to Target Dose 1, Invalid Shot(s) on Record Prior to Season Start

• If the patient has no doses on record but >= 1 invalid shot(s) administered prior to the season start date, intervals to target dose 1: 

  • From a prior season invalid Pfizer (CVX 208, CVX 217, CVX 218, CVX 219, CVX 300, CVX 301, CVX 302, CVX 308, CVX 309, CVX 310); Novavax (CVX 211, CVX 313); or Unspecified (CVX 213):

    • Absolute minimum interval = 17 days 

    • Minimum interval = 21 days 

    • Recommended interval = 21 days 

  • From a prior season invalid COVID-19 vaccine not listed above:   

    • Absolute minimum interval = 24 days

    • Minimum interval = 28 days

    • Recommended interval = 28 days

  • From an invalid this season: Table intervals apply.

Interval to Target Dose 1, 1 Dose of Non-Moderna on Record Prior to Season Start

• If the patient has 1 dose of any of the following non-Moderna COVID-19 vaccines (CVX 213, CVX 308, CVX 309, CVX 310, CVX 313) administered prior to the season start date, intervals to target dose 1: 

  • From a prior season Pfizer (CVX 208, CVX 217, CVX 218, CVX 219, CVX 300, CVX 301, CVX 302, CVX 308, CVX 309, CVX 310); Novavax (CVX 211, CVX 313); or Unspecified (CVX 213)

    • Absolute minimum interval = 17 days

    • Minimum interval = 21 days

    • Recommended interval = 21 days

    • Latest recommended interval (less than) = 8 weeks

  • From a prior season COVID-19 vaccine not listed above: 

    • Absolute minimum interval = 24 days

    • Minimum interval = 28 days

    • Recommended interval = 28 days

  • From an invalid this season: Table intervals apply.

Skip Dose Rules, 1 Dose of Moderna on Record Prior to Season Start

• If the patient has 1 dose of any of the following Moderna COVID-19 vaccines (CVX 311, CVX 312) administered prior to the season start date, target dose 1 is not needed. Skip to target dose 2. Intervals to target dose 2: 

  • From shot(s) administered in the prior season:

    • From a prior season (invalid) Pfizer (CVX 208, CVX 217, CVX 218, CVX 219, CVX 300, CVX 301, CVX 302, CVX 308, CVX 309, CVX 310); Novavax (CVX 211, CVX 313); or Unspecified (CVX 213):

      • Absolute minimum interval: 17 days

      • Minimum interval: 21 days

      • Recommended interval: 21 days

    • From a prior season COVID-19 vaccine not listed above: 

      • Absolute minimum interval: 24 days

      • Minimum interval: 28 days

      • Recommended interval: 28 days

  • From shot(s) administered this season: Table intervals apply.

Skip Dose Rules, >= 2 Doses on Record Prior to Season Start

• If the patient has >= 2 doses of any of the following COVID-19 vaccines (CVX 213, CVX 308, CVX 309, CVX 310, CVX 311, CVX 312, CVX 313) 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 

Series Special Rules

Patients < 19 Years with Prior Dose(s)

• If the patient is < age 19 years, and has >= 1 COVID-19 dose on record prior to the season start date and no in-season doses on record, the recommendation is Conditional with reason codes HIGH_RISK and CLINICAL_PATIENT_DISCRETION.

  • Return earliest and recommended dates based on series rules.¹

Evaluation Intervals for Target Dose 1

• If the patient has >= 1 COVID-19 shot on record prior to dose 1, evaluate using all of the following intervals to target dose 1: 

  • Absolute minimum interval from most recent CVX 313 to the current administered CVX 313 = 17 days 

  • Absolute minimum interval from most recent CVX 313 to a current administered shot other than CVX 313 = 8 weeks - 4 days

  • Absolute minimum interval from most recent shot that is not a CVX 313 to the current administered shot = 8 weeks - 4 days 

Recommendation for Target Dose 1

• If the patient has >= 1 COVID-19 shot on record prior to dose 1,

  • Recommend using the following intervals to target dose 1:²

    • Minimum interval = 8 weeks 

    • Recommended interval = 8 weeks 

  • If the patient is >= 12 years - 8 weeks and the most recent (non-ignored)² shot was <= 12 weeks from the assessment date, return the following SUPPLEMENTAL_TEXT descriptive text: "The interval to target dose 1 depends on the patient's prior history and product to be used. If the last shot was an updated Novavax, Novavax can be administered in 3 weeks (as long as the patient is 12 years of age). If the last shot was not Novavax, administer at an interval of 8 weeks (for administration of Comirnaty, Novavax, or Spikevax) or 12 weeks (for administration of mNEXSPIKE)." 

Series Switch

• If the patient receives dose 1 (i.e., at < 65 years) and will turn age 65 years within 12 months of the season start date, switch to Seasonal 2-dose COVID-19 Series (>= 65 years) starting with target dose 2.

Notes

• ¹ Typically, ICE does not return forecasting dates along with a Conditional recommendation status; however, in this case, ICE will return these dates to support administration in the season following appropriate intervals.

• ² The 8-week interval from a shot on record to target does 1 does not apply when the shot on record is ABOVE_MAX_AGE_VACCINE. If a shot on record is ABOVE_MAX_AGE, the interval is 0 days, per the CVX Special Rule above, CVX Administered Above Absolute Maximum Age.