2023 # 279 Sleep Apnea: Assessment of Adherence to Positive Airway Pressure Therapy

CMS Measure ID: #279

Collection Type: CQM

Reporting Frequency: Once per patient per year

Outcome: No

High Priority: No

NQS Domain: Effective Clinical Care

Measure Age: > 2 years

Instructions

This measure is to be submitted a minimum of once per performance period for patients with sleep apnea 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:

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 for registry-based submissions; however, these codes may be submitted for those registries that utilize claims data.

Description

Percentage of visits for patients aged 18 years and older with a diagnosis of obstructive sleep apnea who were prescribed positive airway pressure therapy who had documentation that adherence to positive airway pressure therapy was objectively measured

2023 Benchmarks (from 2021 CMS data)

Registry

Topped out: Yes
Capped at 7: Yes

Decile 0: 0 – 2.93
Decile 1: 2.94 – 73.12
Minimum: 73.13 – 92.1
Decile 3: 92.11 – 98.78
Decile 4: 98.79 – 99.99
Decile 10: 100 – 100

Denominator

All patients aged 18 years and older with a diagnosis of sleep apnea 

Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter 

AND

Diagnosis for sleep apnea (ICD-10-CM): G47.30, G47.33

AND

Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350

AND

Positive airway pressure therapy was prescribed: G8852

Numerator

Patient visits with documentation that adherence to positive airway pressure therapy was objectively measured

Definition:

Objectively Measured – is defined as positive airway pressure machine-generated measurement of hours of use.

Numerator Options:

Performance Met:

Objective measurement of adherence to positive airway pressure therapy, documented (G8851)

OR

Denominator Exception:

Documentation of reason(s) for not objectively measuring adherence to positive airway pressure therapy (e.g., patient didn’t bring data from continuous positive airway pressure [CPAP], therapy not yet initiated, not available on machine) (G8854)

OR

Performance Not Met:

Objective measurement of adherence to positive airway pressure therapy not performed, reason not given (G8855)