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2021 MIPS Measure #444: Medication Management for People with Asthma

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Measure TypeHigh Priority Measure?Collection Type(s)
ProcessyesMIPS CQM

 

Measure Description

The percentage of patients 5-64 years of age during the measurement year who were identified as having persistent asthma and were dispensed appropriate medications that they remained on for at least 75% of their treatment period


Instructions

This measure is to be submitted a minimum of once per performance period for patients with a diagnosis of persistent asthma seen during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

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 5-64 years of age with persistent asthma and a visit during the measurement period

DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for registry measures.

Denominator Criteria (Eligible Cases):

Patients aged 5-64 years on date of encounter

AND

Diagnosis for persistent asthma (ICD-10-CM): J45.30, J45.31, J45.32, J45.40, J45.41, J45.42, J45.50, J45.51, J45.52

AND

Patient encounter (with or without telehealth) during the performance period (CPT):  99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99381*, 99382*, 99383*, 99384*, 99385*, 99386*, 99387*, 99391*, 99392*, 99393*, 99394*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, 99455, 99456, 99483, G0402, G0438, G0439, G0463, T1015

AND NOT

DENOMINATOR EXCLUSIONS:

Diagnosis of COPD, Emphysema, Obstructive Chronic Bronchitis, Chronic Respiratory Conditions Due to Fumes/Vapors, Cystic Fibrosis, or Acute Respiratory Failure any time during the patient’s history through the end of the measurement year: E84.0, E84.11, E84.19, E84.8, E84.9, J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, J44.9, J68.4, J96.00, J96.01, J96.02, J96.20, J96.21, J96.22, J98.2, J98.3

OR

Any patients who had no asthma controller medications dispensed during the measurement year: G9808

OR

Patients who use hospice services any time during the measurement period: G9809

Numerator

The number of patients who achieved a proportion of days (PDC) of at least 75% for their asthma controller medications during the measurement year

Definition:

PDC- The proportion of days covered by at least one asthma controller medication prescription, divided by the number of days in the treatment period. The treatment period is the period of time beginning on the earliest prescription dispensing date for any asthma controller medication during the measurement year through the last day of the measurement year.

Asthma Controller Medications

Description

Prescriptions

Medication Lists

Route

Antiasthmatic combinations

Dyphylline-guaifenesin

Dyphylline Guaifenesin Medications List

Oral

Antibody inhibitors

Omalizumab

Omalizumab Medications List

Subcutaneous

Anti-interleukin-5

Benralizumab

Benralizumab Medications List

Subcutaneous

Anti-interleukin-5

Mepolizumab

Mepolizumab Medications List

Subcutaneous

Anti-interleukin-5

Reslizumab

Reslizumab Medications List

Intravenous

Inhaled steroid combinations

Budesonide-formoterol

Budesonide Formoterol Medications List

Inhalation

Inhaled steroid combinations

Fluticasone-salmeterol

Fluticasone Salmeterol Medications List

Inhalation

Inhaled steroid combinations

Fluticasone-vilanterol

Fluticasone Vilanterol Medications List

Inhalation

Inhaled steroid combinations

Formoterol-mometasone

Formoterol Mometasone Medications List

Inhalation

Inhaled corticosteroids

Beclomethasone

Beclomethasone Medications List

Inhalation

Inhaled corticosteroids

Budesonide

Budesonide Medications List

Inhalation

Inhaled corticosteroids

Ciclesonide

Ciclesonide Medications List

Inhalation

Inhaled corticosteroids

Flunisolide

Flunisolide Medications List

Inhalation

Inhaled corticosteroids

Fluticasone

Fluticasone Medications List

Inhalation

Inhaled corticosteroids

Mometasone

Mometasone Medications List

Inhalation

Leukotriene modifiers

Montelukast

Montelukast Medications List

Oral

Leukotriene modifiers

Zafirlukast

Zafirlukast Medications List

Oral

Leukotriene modifiers

Zileuton

Zileuton Medications List

Oral

Methylxanthines

Theophylline

Theophylline Medications List

Oral

Asthma Reliever Medications

Description

Prescriptions

Medication Lists

Route

Short-acting, inhaled beta-2 agonists

Albuterol

Albuterol Medications List

Inhalation

Short-acting, inhaled beta-2 agonists

Levalbuterol

Levalbuterol Medications List

Inhalation



Numerator Options:

Performance Met:

Patient achieved a PDC of at least 75% for their asthma controller medication (G9810)

OR

Performance Not Met:

Patient did not achieve a PDC of at least 75% for their asthma controller medication (G9811)

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