2021 MIPS Measure #338: HIV Viral Load Suppression

Measure Description

The percentage of patients, regardless of age, with a diagnosis of HIV with a HIV viral load less than 200 copies/mL at last HIV viral load test during the measurement year

Instructions

This measure is to be submitted a minimum of once per performance period for patients with HIV seen during the performance period. This measure is intended to reflect the quality of services provided for the primary management of patients with HIV.

NOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.

Measure Submission Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

Denominator

Patients, regardless of age, with a diagnosis of HIV who had at least one medical visit during the performance period

Denominator Criteria (Eligible Cases):

Patients, regardless of age

AND

Diagnosis of HIV (ICD-10-CM): B20, B21, B22, B23, B24, Z21

AND

Patient encounter during the performance period (CPT or HCPCS): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, G0402

Numerator

Number of patients with a HIV viral load less than 200 copies/mL at last viral load test

Numerator Options:

Performance Met:

Documentation of viral load less than 200 copies/mL (G9243)

OR

Performance Not Met:

Documentation of viral load equal to or greater than 200 copies/mL or viral load not performed (G9242)