Supported MCIR Vaccine Codes Including U.S. Licensed CVX, CPT-4, and MVX

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1 Supported MCIR Vaccine s Including U.S. Licensed CVX, CPT-4, and MVX Name Product Name Vaccine Name (CPT ) Adenovirus 4,7, live, Adenovirus types 4 Barr 143 Adenovirus types 4 and 7 BRR oral and 7 Laboratories 24 Anthrax BIOTHRAX Anthrax BioPort MIP 181 Anthrax Immune Globulin Anthrax Immune Globulin Anthrax Immune Globulin 19 BCG MYCOBAX BCG: Bacilus of Calmette & Guerin Sanofi PMC 19 BCG TICE BCG BCG: Bacilus of Calmette & Guerin Botulinum Antitoxin Botulinum Antitoxin Organon teknika 174 Cholera (Vaxchora) Vaxchora Cholera, live attenuated PaxVax PAX 29 CMVIG (IV) CMVIG (IV): Cytomegalovirus globulin MAPH MA 12 Diphtheria antitoxin DT (pediatric) DT (GENERIC) Diphtheria-Tetanus (DT pediatric) Sanofi PMC 106 DTaP DAPTACEL DTaP (5 pertussis) None Sanofi PMC 20 DTaP (Pediatric TRIPEDIA DTaP Sanofi PMC 20 DTaP (Pediatric) INFANRIX DTaP GlaxoSmithKline SKB 110 DTaP-HepB-IPV (Pediarix) PEDIARIX DTaP-HepB-IPV GlaxoSmithKline SKB MCIR Helpdesk at MPHI Page DTaP-Hib TRIHIBIT DTaP-Hib Sanofi PMC 120 DTaP-Hib-IPV (Pentacel) PENTACEL DTaP-Hib-IPV Sanofi PMC 130 DTaP-IPV KINRIX DTaP-IPV GlaxoSmithKline SKB 130 DTaP-IPV Quadracel DTaP-IPV Sanofi PMC 30 HBIG: HepB globulin HBIG: Hep B globulin NABI NAB 52 HepA Adult HAVRIX-ADULT Hepatitis A adult GlaxoSmithKline SKB 52 HepA Adult VAQTA-ADULT Hepatitis A adult Merck MSD 83 HepA Ped/Adol HAVRIX-PEDS Hepatitis A Pediatric GlaxoSmithKline SKB 83 HepA Ped/Adol VAQTA-PEDS Hepatitis A Pediatric Merck MSD 104 HepA-HepB (Twinrix) TWINRIX Hepatitis A-Hepatitis B GlaxoSmithKline SKB 43 HepB (adult) RECOMBIVAX- ADULT Hepatitis B adult (HepB) Merck MSD 43 HepB (adult) RECOMBIVAX- ADULT Hepatitis B adolescent (2 dose) Merck MSD 43 Hep B (adult) ENGERIX-B-ADULT Hepatitis-B adult (HepB) GlaxoSmithKline SKB OTC

2 Supported MCIR Vaccine s Including U.S. Licensed CVX, CPT-4, and MVX Name 44 HepB (dialysis) 44 HepB (dialysis) Product Name RECOMBIVAX- Dialysis (3 dose schedule) ENGERIX-Dialysis (4 dose schedule Vaccine Name (CPT ) MCIR Helpdesk at MPHI Page Hepatitis B (dialysis) 3 dose Merck MSD Hepatitis B (dialysis) 4 dose GlaxoSmithKline SKB 08 HpeB (ped/adol) ENGERIX-B-PEDS Hepatitis B pediatric or adolescent GlaxoSmithKline SKB 08 HepB (ped/adol) RECOMBIVAX-PEDS Hepatitis B pediatric or adolescent Merck MSD 48 Hib (ActHib/Hiberix) ACTHIB Haemophilus influenza type b (Hib) Sanofi PMC 48 Hib (ActHib/Hiberix) HIBERIX Haemophilus influenza type b (Hib) GlaxoSmithKline SKB Haemophilus influenzae type b 49 Hib (PedvaxHIB) PEDVAXHIB Merck MSD (Hib)(3dose) 148 HIBMENCY MENHIBRIX Meningococcal C/Y-HIB PRP GlaxoSmithKline SKB 118 HPV2 CERVARIX HPV, bivalent (HPV2) GlaxoSmithKline SKB 62 HPV4 GARDASIL Human Papillomavirus (HPV4) Merck MSD 165 HPV9 GARDASIL9 Human Papillomavirus 9-valent vaccine Merck MSD 87 Immune Globulin - IV Immune Globulin - IV Baxter BAX Talecris TAL 86 Immune Globulin IM GAMASTAN Immune Globulin - IM Talecris TAL FLUARIX ect. GlaxoSmithKline SKB FLUVIRIN ect Seqirus SEQ AFLURIA ect CSL CSL AFLURIA ect Seqirus SEQ FLUZONE ect Sanofi PMC 141 Influenza IIV3 ect AFLURIA Influenza IIV3 ect CSL CSL 141 Influenza IIV3 inject FLUVIRIN Influenza IIV3 ect Seqirus SEQ 141 Influenza IIV3 ect FLUZONE Influenza IIV3 ect Sanofi PMC

3 Supported MCIR Vaccine s Including U.S. Licensed CVX, CPT-4, and MVX Name Product Name Vaccine Name 141 Influenza IIV3 ect FLULAVAL Influenza IIV3 ect 144 Influenza IIV3 FLUZONE, intradermal 168 Influenza IIV3 FLUAD 135 Influenza IIV3 High Dose FLUZONE-HIGH DOSE Influenza Intradermal IIV3 (P-Free, Intradermal) Influenza, trivalent, adjuvanted, preservative free 158 Influenza IIV4 ect FLULAVAL Influenza IIV4 ect, quadrivalent 158 Influenza IIV4 ect FLULAVAL Influenza IIV4 ect, quadrivalent 158 Influenza IIV4 ect FLUZONE Influenza IIV4 ect (CPT ) ID Biomedical IDB Sanofi PMC Seqirus SEQ Influenza High Dose (IIV3) Sanofi PMC GlaxoSmithKline (inactive) Biomedical Sanofi 158 Influenza IIV4 ect Afluria Influenza, injectable, quadrivalent Seqirus SEQ SKB IDB PMC 161 Influenza IIV4 Ped P-Free, inject FLUZONE Influenza Shot (IIV4) (P-Free, ect) Pediatric Sanofi PMC Influenza IIV4 (P- Free), inject Afluria Influenza, injectable, quadrivalent, preservative free Seqirus SEQ Influenza IIV4 P-Free, inj FLUARIX Influenza IIV4 P-Free, ect GlaxoSmithKline SKB Influenza IIV4 P-Free, FLULAVAL Influenza IIV4 P-Free, ect GlaxoSmithKline (inactive) SKB Influenza IIV4 P-Free, FLULAVAL Influenza IIV4 P-Free, ect Biomedical IDB Influenza IIV4 P-Free, FLUZONE Influenza IIV4 P-Free, ect Sanofi PMC Influenza IIV4 (P- free, inject) intradermal Influenza cciiv4 (Flucelvax Quad P- free, inj) FLUZONE Flucelvax Influenza, intradermal, quadrivalent, preservative free Influenza, injectable, MDCK, preservative free, quadrivalent Sanofi PMC Seqirus SEQ MCIR Helpdesk at MPHI Page

4 Supported MCIR Vaccine s Including U.S. Licensed CVX, CPT-4, and MVX Name Influenza LAIV4 (Flumist) Influenza RIV3 (Flublok, P-Free) Influenza RIV4 (Flublok quad, P- Free) Influenza cciiv4 (Flucelvax, quad, preserv) Product Name Flumist Flublok Flublok Flucelvax Vaccine Name Influenza intranasal (LAIV4) Influenza RIV3 (P-Free, ect) (Recombiant HA Trivalent) Influenza, recombinant, quadrivalent, injectable, preservative free Influenza, injectable, MDCK, quadrivalent, preservative (CPT ) MCIR Helpdesk at MPHI Page Medimmune MED Protein Sciences Protein Sciences Seqirus 10 IPV (polio) IPOL Polio (IPV) Sanofi PMC 134 Japanese Encephalitis IM Ixiaro Japanese Encephalitis IM Valneva VAL 114 MCV4 (Menactra) MENACTRA Meningococcal Conjugate Sanofi PMC 136 MCV4O (Menveo) MENVEO Meningococcal Oligosaccharide GlaxoSmithKline SKB 162 Meningococcal B, Meningococcal B vaccine, fully Trumenba recombinant recombinant Pfizer PFR 163 Meningococcal B, Meningococcal B vaccine, Bexsero OMV recombinant, OMV, adjuvanted GlaxoSmithKline SKB 03 MMR M-M-R II MMR Merck MSD 94 MMRV (ProQuad) PROQUAD MMRV Merck MSD 32 MPSV4 (Menomune) MENOMUNE Meningococcal Polysaccharide (MPSV4) Sanofi PMC 07 Mumps MUMPSVAX Mumps Merck MSD 133 PCV13 Prevnar PREVNAR 13 Pneumoccoccal Conjugate, 13 Wyeth valent (inactive) WAL 133 PCV13 Prevnar PREVNAR 13 Pneumoccoccal Conjugate, 13 valent Pfizer PFR 23 Plague Plague PPD Intradermal Tubersol Tuberculin Skin Test (TST) PPD Sanofi PMC 96 PPD Intradermal Aplisol Tuberculin-TST PPD Parkdale PD 33 PPSV23 (Pneumovax) PNEUMOVAX 23 Pneumococcal Polysaccharide Merck MSD 40 Rabies ID ection RabAvert Rabies ID Intradermal inject Chiron CHI 40 Rabies ID ection IMOVAX ID Rabies ID Intradermal ect Sanofi PMC 175 Rabies-IM Diploid IMOVAX IM Diploid cell culture Sanofi PMC 176 Rabies-IM Fibroblast RABAVERT IM Fibroblast culture GlaxoSmithKline SKB PSC PSC SEQ

5 Supported MCIR Vaccine s Including U.S. Licensed CVX, CPT-4, and MVX Name 176 Rabies-IM Fibroblast 156 Rho(D)IG-IV or IM 157 Rho(D)IG-IM Product Name RABAVERT Rho(D) Immune Globulin IV or IM Rho(D) Immune Globulin IM Vaccine Name IM Fibroblast culture Rho(D)-Immune Globulin IV or IM Rho(D) Immune Globulin IM (CPT ) Novartis (inactive) 34 RIG:Rabies globulin HyperRAB RIG-HIT Grifols GRF 34 RIG:Rabies globulin Imogam RIG Sanofi PMC 34 RIG:Rabies globulin HyperRAB RIG-HT Talecris TAL 93 RSV-MAB (Synagis) Synagis RSV-MAB IM Medimmune MED 06 Rubella MERUVAX II Rubella Merck 119 RV1 (Rotarix) ROTARIX Rotavirus Monovalent (2-dose, Rotarix, RV1) GlaxoSmithKline SKB 116 RV5 (Rotateq) ROTATEQ Rotavirus Pentavalent (3-dose, Rotateq, RV5) Merck MSD 75 Smallpox ACAM2000 Smallpox (Vaccinia) None Acambis ACA 75 Smallpox ACAM2000 Smallpox (Vaccinia) None Sanofi Pasteur PMC 09 Td (adult) adsorbed Tetanus-diphtheria adult (Td) Massachusetts Td (adult) adsorbed (adsorbed PF, Td, Td adsorbed) Biologic MBL 113 Td PF Adol/Adult DECAVAC Tetanus-diphtheria adult Td P-Free Sanofi PMC 113 Td PF Adol/Adult Tenivac Tetanus-diphtheria adult Td P-Free Sanofi PMC 113 Td PF Adol/Adult Tetanus-diphtheria adult Td P-Free Massachusetts Biologic MBL 115 Tdap Adol/Adult ADACEL Tdap Adol/Adult Sanofi PMC 115 Tdap Adol/Adult BOOSTRIX Tdap Adol/Adult GlaxoSmithKline SKB 13 TIG: Tetanus Immune Globulin TIG: Tetanus Immune Globulin Talecris TAL 25 Typhoid (oral VIVOTIF Typhoid (oral) PaxVax PAX 101 Typhoid ViCPS TYPHIM VI Typhoid Sanofi PMC 79 Vaccinia IG Vaccinia IG Vaccinia Immune Globulin Varicella (Varivax) VARIVAX Varicella (VAR) Merck MSD 36 VZIG VZIG: Varicella zoster globulin MCIR Helpdesk at MPHI Page NOV MSD

6 Supported MCIR Vaccine s Including U.S. Licensed CVX, CPT-4, and MVX Name Product Name Vaccine Name (CPT ) 37 Yellow Fever YF-VAX Yellow Fever (YF) Sanofi PMC 183 Yellow Fever Stamaril Yellow Fever-alternative formulation None Sanofi PMC 187 Zoster HZ/su (Shingrix) 121 Zoster ZVL (Zostavax) ZOSTAVAX SHINGRIX Zoster subunit GlaxoSmithKline SKB Zoster (Herpes Zoster, Shingles, ZOS) Merck MSD MCIR Helpdesk at MPHI Page

7 Vaccine MCIR DISPLAY Supported MCIR Vaccine s and VACCINE NAME MCIR Helpdesk at MPHI Page Terminology (CPT-4) 26 Cholera Cholera Comvax (Hib-HepB) Haemophilus influenzae type b-hepatitis B (Hib-HepB) Diphtheria, tetanus toxoids and acellular 107 DTaP (unspecified) pertussis vaccine, unspecified formulation DTP Diphtheria, tetanus toxoids and pertussis vaccine DTP-Hib TETRAMUNE DTP-Hib HepA adult (unspecified) HepA ped/adol, 3 dose Hepatitis A vaccine, pediatric/adolescent dosage, 3 dose schedule HepB, adolescent/high risk RECOMBIVAX HB Hep B, adolescent/high infant risk infant HepB (unspecified) Hib (Hib TITER) Haemophilus influenzae type b (Hib TITER) Hib (unspecified) Hib (unspecified) Hib (Pro HIBIT) PROHIBIT Haemophilus influenzae type b vaccine, PRP-D conjugate HPV (unspecified) 111 Influenza LAIV (Flumist) Flumist- Influenza intranasal (LAIV) Influenza (unspecified) Influenza whole 151 Influenza Nasal-(unspecified) 153 Influenza cciiv3 (Flucelvax P- Free) FLUCELVAX Influenza cciiv3 (P-Free ect) (manf: NOV) ISG/IgG (unspecified) Influenza-H1N1-09, preservative-free 127 Influenza-H1N1-09 Influenza virus vaccine, pandemic formulation, split-virus, preservative free, for intramuscular use Influenza virus vaccine, pandemic formulation, split-virus, for intramuscular use 39 Japanese Encephalitis SC Japanese Encephalitis (SC) Japanese Encephalitits (unsp) Japanese Encephalitits (unspecified) 66 Lyme Vaccine Lyme Vaccine Measles Attenuvax Measles MCV4 (unspecified) Meningococcal MCV4, unspecified formulation 90734

8 Vaccine MCIR DISPLAY Supported MCIR Vaccine s and VACCINE NAME 108 Meningococcal (unspecified) Meningococcal MCIR Helpdesk at MPHI Page Terminology (CPT-4) 164 Meningococcal B (unspecified) 04 MR(Measles-Rubella) M/R: Measles-Rubella OPV (Polio) ORIMUNE poliovirus vaccine, live, oral OPV OPV 100 PCV7 (Prevnar) Prevnar7 Pneumococcal Conjugate (PCV7) PCV unspecified 11 Pertussis Pertussis None 109 Pneumococcal vaccine, unspecified 89 Polio (unspecified) 90 Rabies (unspecified) Rabies, unspecified formuation Rabies vaccine, for intramuscular use Rabies, unspecified formulation Rabies IMOVAX, Rabavert 74 Rotavirus, Tetravalent RV7 (Rotoshield) 38 Rubella-Mumps BiavaxII Rubella/Mumps None 122 RV (unspecified) Rotovirus 139 Td (adult)inactive-(unspecified) Td (adult) Td (adult) Tetanus and Diphtheria Toxoids, not absorbed, for adult use 35 Tetanus Toxoid, Absorbed Tetanus Toxoid Adsorbed(TT) Tetanus Toxoid, unsp Tetanus Toxoid, unspecified formulation 142 Tetanus Toxoid, not adsorbed Tetanus Toxoid, not adsorbed 98 TST, unspecified Tuberculin skin test, unspecified formulation 91 Typhoid (unspecified) Typhoid (unspecified) 41 Typhoid (Parenteral) Typhoid Typhoid Parenteral, AKD (U.S. military) Typhoid VZIG (IND) VZIG (IND) None 184 Yellow Fever Yellow Fever None 188 Zoster Zoster

9 Vaccine MCIR DISPLAY Supported MCIR Vaccine s and Vaccine Name For MCIR HEDIS query results (not used for MCIR reporting) 903 Antiviral: Osteltamivir (Tamiflu) Tamiflu 904 Antiviral: Anamivir (Relenza) Relenza No longer used in MCIR Reporting after March 2011: "Influenza TIV (Historical)" 15 influenza, split (incl. purified surface antigen) Influenza, split No longer used in MCIR Reporting after 1998 HepA Pediatric (, 31 HepA Ped, historical historical) MCIR does not support electronic submission of H1N1 Influenza nasal & unspecified Novel Influenza-H1N1-09, Influenza virus vaccine, pandemic 125 nasal formulation, live, for intranasal use Influenza virus vaccine, pandemic 128 H1N1 Influenza formulation, unspecified Terminolog y (CPT-4) None None MCIR Helpdesk at MPHI Page

Supported MCIR Vaccine Codes Including U.S. Licensed CVX, CPT-4, and MVX

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