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AB2026-08-003 Quality information

Capital Blue Cross·Pediatrics, Family Medicine, General Practice +1 more·Provider News
Effective date
Aug 1, 2026
We identified it
Jul 31, 2026
Days to comply
1 days

Summary

Capital Blue Cross issued an administrative bulletin clarifying HEDIS quality measure requirements for childhood immunization (CIS-E), flu vaccines, and adolescent immunization (IMA-E) across multiple plan types. This is a policy clarification with specific coding guidance for vaccine administration and documentation requirements to ensure compliance with CDC guidelines. Billing teams must ensure all vaccine-related claims use the correct CPT and CVX codes listed in the guidance.

Action Required

Before Aug 1, 2026
By August 15, 2026: Billing team must verify all vaccine claims submitted to Capital Blue Cross use ONLY the CPT and CVX codes specified in bulletin AB2026-08-003. Update billing software validation rules to reject claims using incorrect vaccine codes for DTaP, IPV, MMR, HiB, HepB, VZV, PCV, HepA, RV, Influenza (including LAIV), Meningococcal, and Tdap. Providers must document vaccine administration with correct CPT codes (90697, 90698, 90700, 90723, 90633, 90740, 90744, 90747, 90748, 90644, 90647, 90648, 90655, 90656, 90657, 90658, 90661, 90674, 90685, 90686, 90687, 90688, 90689, 90756, 90660, 90672, 90713, 90707, 90710, 90670, 90671, 90677, 90680, 90681, 90716) or HCPCS codes (G0010, G0009). Front desk and clinical staff must ensure well-child visits are scheduled before age 2 and adolescent visits before age 13 to capture immunizations within measurement windows. Ensure EMR alerts flag overdue vaccines per CDC timelines. Claims submitted with non-compliant codes or without proper documentation of vaccine administration will be denied and require resubmission. Contact your Capital Blue Cross Provider Engagement Consultant for questions or use capbluecross.com/wps/portal/cap/provider/pec-look-up to verify your designated point of contact.

Affected Billing Codes

90697
90698
90700
90723
90633
90740
90744
90747
90748
90644
90647
90648
90655
90656
90657
90658
90661
90674
90685
90686
90687
90688
90689
90756
90660
90672
90713
90707
90710
90670
90671
90677
90680
90681
90716
G0010
G0009