2023 # 400 One-Time Screening for Hepatitis C Virus (HCV) for all Patients

CMS Measure ID: #400

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 all patients >= 18 years of age seen during the performance period AND who were seen twice for any visits or who had at least one preventive visit within the 12-month 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 submissions; however, these codes may be submitted for those registries that utilize claims data.

Description

Percentage of patients age >= 18 years who received one-time screening for hepatitis C virus (HCV) infection.

Denominator

All patients >= 18 years of age who had at least one preventitive visit OR were seen at least twice within the 12-month reporting 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 MIPS CQMs.

Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years

AND

At least one preventive encounter during the performance period (CPT or HCPCS): 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, G0438, G0439

OR

At least two patient encounters during the performance period (CPT): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350

AND NOT

DENOMINATOR EXCLUSION:

Diagnosis for Chronic Hepatitis C (ICD-10-CM): B18.2

Numerator

Patients who received one-time screening for HCV infection

NUMERATOR NOTE: Denominator Exception(s) are determined on the date of the most recent denominator eligible encounter.

Definition:

Screening for HCV Infection includes current or prior receipt of:

1. HCV antibody test
2. HCV RNA test
3. Recombinant immunoblot assay (RIBA) test (if performed at any time in the past)

Numerator Options:

Performance Met:

Patient received one-time screening for HCV infection (G9451)

OR

Denominator Exception:

Documentation of medical reason(s) for not receiving one-time screening for HCV infection (e.g., decompensated cirrhosis indicating advanced disease [i.e., ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular carcinoma, waitlist for organ transplant, limited life expectancy, other medical reasons) (G9452)

OR

Denominator Exception:

Documentation of patient reason(s) for not receiving one-time screening for HCV infection (e.g., patient declined, other patient reasons) (G9453)

OR

Performance Not Met:

One-time screening for HCV infection not received within 12 month reporting period and no documentation of prior screening for HCV infection, reason not given (G9454)