|Measure Type||High Priority Measure?||Collection Type(s)|
|Process||no||Medicare Part B Claims, MIPS CQM|
The percentage of women age 50-85 who suffered a fracture in the six months prior to the performance period through June 30 of the performance period and who either had a bone mineral density test or received a prescription for a drug to treat osteoporosis in the six months after the fracture
This measure is to be submitted after each occurrence of a fracture during the six months prior to the performance period through June 30 of the performance period. It is anticipated that clinicians who treat any fracture except fractures of the finger, toe, face or skull will submit this measure. Each occurrence of a fracture is identified by either an ICD-10-CM diagnosis code for fracture and a CPT service code OR an ICD-10-CM diagnosis code for a fracture and a CPT procedure code for surgical treatment of fractures.
NOTE: Patients with any fracture except fractures of the finger, toe, face or skull should have a bone mineral density (BMD) measurement performed or pharmacologic therapy prescribed. The management (BMD performed or pharmacologic therapy prescribed) should occur within six months of the fracture. If multiple fractures occurring on the same date of service are submitted on the same claim form, only one instance of submission will be counted. Claims data will be analyzed to determine unique occurrences. Patients already receiving pharmacologic therapy would automatically meet the intent of this measure..
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.
The intent of the exclusion for individuals age 66 and older residing in long-term care facilities, including nursing homes, is to exclude individuals who may have limited life expectancy and increased frailty where the benefit of the process may not exceed the risks. This exclusion is not intended as a clinical recommendation regarding whether the measures process is inappropriate for specific populations, instead the exclusions allows clinicians to engage in shared decision making with patients about the benefits and risks of screening when an individual has limited life expectancy.
Women who experienced a fracture, except fractures of the finger, toe, face or skull, during the six months prior to the performance period through June 30 of the performance period.
Option 1 – Denominator Criteria (Eligible Cases):
Patients aged 50-85 years on date of encounter
Diagnosis for any fracture except fractures of the finger, toe, face or skull (ICD-10-CM):
M48.40XA, M48.41XA, M48.42XA, M48.43XA, M48.44XA, M48.45XA, M48.46XA, M48.47XA, M48.48XA, M80.00XA, M80.011A, M80.012A, M80.019A, M80.021A, M80.022A, M80.029A, M80.031A, M80.032A, M80.039A, M80.041A, M80.042A, M80.049A, M80.051A, M80.052A, M80.059A, M80.061A, M80.062A, M80.069A, M80.071A, M80.072A, M80.079A, M80.08XA, M80.80XA, M80.811A, M80.812A, M80.819A, M80.821A, M80.822A, M80.829A, M80.831A, M80.832A, M80.839A, M80.841A, M80.842A, M80.849A, M80.851A, M80.852A, M80.859A, M80.861A, M80.862A, M80.869A, M80.871A, M80.872A, M80.879A, M80.88XA, M80.0AXA, M80.8AXA, M84.311A, M84.312A, M84.319A, M84.321A, M84.322A, M84.329A, M84.331A, M84.332A, M84.333A, M84.334A, M84.339A, M84.341A, M84.342A, M84.343A, M84.350A, M84.351A, M84.352A, M84.353A, M84.359A, M84.361A, M84.362A, M84.363A, M84.364A, M84.369A, M84.371A, M84.372A, M84.373A, M84.374A, M84.375A, M84.376A, M84.38XA, M84.750A, M84.751A, M84.752A, M84.753A, M84.754A, M84.755A, M84.756A, M84.757A, M84.759A, M97.01XA, M97.02XA, M97.11XA, M97.12XA, M97.21XA, M97.22XA, M97.31XA, M97.32XA, M97.41XA, M97.42XA, S12.000A, S12.000B, S12.001A, S12.001B, S12.01XA, S12.01XB, S12.02XA, S12.02XB, S12.030A, S12.030B, S12.031A, S12.031B, S12.040A, S12.040B, S12.041A, S12.041B, S12.090A, S12.090B, S12.091A, S12.091B, S12.100A, S12.100B, S12.101A, S12.101B, S12.110A, S12.110B, S12.111A, S12.111B, S12.112A, S12.112B, S12.120A, S12.120B, S12.121A, S12.121B, S12.130A, S12.130B, S12.131A, S12.131B, S12.14XA, S12.14XB, S12.150A, S12.150B, S12.151A, S12.151B, S12.190A, S12.190B, S12.191A, S12.191B, S12.200A, S12.200B, S12.201A, S12.201B, S12.230A, S12.230B, S12.231A, S12.231B, S12.24XA, S12.24XB, S12.250A, S12.250B, S12.251A, S12.251B, S12.290A, S12.290B, S12.291A, S12.291B, S12.300A, S12.300B, S12.301A, S12.301B, S12.330A, S12.330B, S12.331A, S12.331B, S12.34XA, S12.34XB, S12.350A, S12.350B, S12.351A, S12.351B, S12.390A, S12.390B, S12.391A, S12.391B, S12.400A, S12.400B, S12.401A, S12.401B, S12.430A, S12.430B, S12.431A, S12.431B, S12.44XA, S12.44XB, S12.450A, S12.450B, S12.451A, S12.451B, S12.490A, S12.490B, S12.491A, S12.491B, S12.500A, S12.500B, S12.501A, S12.501B, S12.530A, S12.530B, S12.531A, S12.531B, S12.54XA, S12.54XB, S12.550A, S12.550B, S12.551A, S12.551B, S12.590A, S12.590B, S12.591A, S12.591B, S12.600A, S12.600B, S12.601A, S12.601B, S12.630A, S12.630B, S12.631A, S12.631B, S12.64XA, S12.64XB, S12.650A, S12.650B, S12.651A, S12.651B, S12.690A, S12.690B, S12.691A, S12.691B, S12.8XXA, S12.9XXA, S22.000A, S22.000B, S22.001A, S22.001B, S22.002A, S22.002B, S22.008A, S22.008B, S22.009A, S22.009B, S22.010A, S22.010B, S22.011A, S22.011B, S22.012A, S22.012B, S22.018A, S22.018B, S22.019A, S22.019B, S22.020A, S22.020B, S22.021A, S22.021B, S22.022A, S22.022B, S22.028A, S22.028B, S22.029A, S22.029B, S22.030A, S22.030B, S22.031A, S22.031B, S22.032A, S22.032B, S22.038A, S22.038B, S22.039A, S22.039B, S22.040A, S22.040B, S22.041A, S22.041B, S22.042A, S22.042B, S22.048A, S22.048B, S22.049A, S22.049B, S22.050A, S22.050B, S22.051A, S22.051B, S22.052A, S22.052B, S22.058A, S22.058B, S22.059A, S22.059B, S22.060A, S22.060B, S22.061A, S22.061B, S22.062A, S22.062B, S22.068A, S22.068B, S22.069A, S22.069B, S22.070A, S22.070B, S22.071A, S22.071B, S22.072A, S22.072B, S22.078A, S22.078B, S22.079A, S22.079B, S22.080A, S22.080B, S22.081A, S22.081B, S22.082A, S22.082B, S22.088A, S22.088B, S22.089A, S22.089B, S22.20XA, S22.20XB, S22.21XA, S22.21XB, S22.22XA, S22.22XB, S22.23XA, S22.23XB, S22.24XA, S22.24XB, S22.31XA, S22.31XB, S22.32XA, S22.32XB, S22.39XA, S22.39XB, S22.41XA, S22.41XB, S22.42XA, S22.42XB, S22.43XA, S22.43XB, S22.49XA, S22.49XB, S22.5XXA, S22.5XXB, S22.9XXA, S22.9XXB, S32.000A, S32.000B, S32.001A, S32.001B, S32.002A, S32.002B, S32.008A, S32.008B, S32.009A, S32.009B, S32.010A, S32.010B, S32.011A, S32.011B, S32.012A, S32.012B, S32.018A, S32.018B, S32.019A, S32.019B, S32.020A, S32.020B, S32.021A, S32.021B, S32.022A, S32.022B, S32.028A, S32.028B, S32.029A, S32.029B, S32.030A, S32.030B, S32.031A, S32.031B, S32.032A, S32.032B, S32.038A, S32.038B, S32.039A, S32.039B, S32.040A, S32.040B, S32.041A, S32.041B, S32.042A, S32.042B, S32.048A, S32.048B, S32.049A, S32.049B, S32.050A, S32.050B, S32.051A, S32.051B, S32.052A, S32.052B, S32.058A, S32.058B, S32.059A, S32.059B, S32.10XA, S32.10XB, S32.110A, S32.110B, S32.111A, S32.111B, S32.112A, S32.112B, S32.119A, S32.119B, S32.120A, S32.120B, S32.121A, S32.121B, S32.122A, S32.122B, S32.129A, S32.129B, S32.130A, S32.130B, S32.131A, S32.131B, S32.132A, S32.132B, S32.139A, S32.139B, S32.14XA, S32.14XB, S32.15XA, S32.15XB, S32.16XA, S32.16XB, S32.17XA, S32.17XB, S32.19XA, S32.19XB, S32.2XXA, S32.2XXB, S32.301A, S32.301B, S32.302A, S32.302B, S32.309A, S32.309B, S32.311A, S32.311B, S32.312A, S32.312B, S32.313A, S32.313B, S32.314A, S32.314B, S32.315A, S32.315B, S32.316A, S32.316B, S32.391A, S32.391B, S32.392A, S32.392B, S32.399A, S32.399B, S32.401A, S32.401B, S32.402A, S32.402B, S32.409A, S32.409B, S32.411A, S32.411B, S32.412A, S32.412B, S32.413A,S32.413B, S32.414A, S32.414B, S32.415A, S32.415B, S32.416A, S32.416B, S32.421A, S32.421B, S32.422A, S32.422B, S32.423A, S32.423B, S32.424A, S32.424B, S32.425A, S32.425B, S32.426A, S32.426B, S32.431A, S32.431B, S32.432A, S32.432B, S32.433A, S32.433B, S32.434A, S32.434B, S32.435A, S32.435B, S32.436A, S32.436B, S32.441A, S32.441B, S32.442A, S32.442B, S32.443A, S32.443B, S32.444A, S32.444B, S32.445A, S32.445B, S32.446A, S32.446B, S32.451A, S32.451B, S32.452A, S32.452B, S32.453A, S32.453B, S32.454A, S32.454B, S32.455A, S32.455B, S32.456A, S32.456B, S32.461A, S32.461B, S32.462A, S32.462B, S32.463A, S32.463B, S32.464A, S32.464B, S32.465A, S32.465B, S32.466A, S32.466B, S32.471A, S32.471B, S32.472A, S32.472B, S32.473A, S32.473B, S32.474A, S32.474B, S32.475A, S32.475B, S32.476A, S32.476B, S32.481A, S32.481B, S32.482A, S32.482B, S32.483A, S32.483B, S32.484A, S32.484B, S32.485A, S32.485B, S32.486A, S32.486B, S32.491A, S32.491B, S32.492A, S32.492B, S32.499A, S32.499B, S32.501A, S32.501B, S32.502A, S32.502B, S32.509A, S32.509B, S32.511A, S32.511B, S32.512A, S32.512B, S32.519A, S32.519B, S32.591A, S32.591B, S32.592A, S32.592B, S32.599A, S32.599B, S32.601A, S32.601B, S32.602A, S32.602B, S32.609A, S32.609B, S32.611A, S32.611B, S32.612A, S32.612B, S32.613A, S32.613B, S32.614A, S32.614B, S32.615A, S32.615B, S32.616A, S32.616B, S32.691A, S32.691B, S32.692A, S32.692B, S32.699A, S32.699B, S32.810A, S32.810B, S32.811A, S32.811B, S32.82XA, S32.82XB, S32.89XA, S32.89XB, S32.9XXA, S32.9XXB, S42.001A, S42.001B, S42.002A, S42.002B, S42.009A, S42.009B, S42.011A, S42.011B, S42.012A, S42.012B, S42.013A, S42.013B, S42.014A, S42.014B, S42.015A, S42.015B, S42.016A, S42.016B, S42.017A, S42.017B, S42.018A, S42.018B, S42.019A, S42.019B, S42.021A, S42.021B, S42.022A, S42.022B, S42.023A, S42.023B, S42.024A, S42.024B, S42.025A, S42.025B, S42.026A, S42.026B, S42.031A, S42.031B, S42.032A, S42.032B, S42.033A, S42.033B, S42.034A, S42.034B, S42.035A, S42.035B, S42.036A, S42.036B, S42.101A, S42.101B, S42.102A, S42.102B, S42.109A, S42.109B, S42.111A, S42.111B, S42.112A, S42.112B, S42.113A, S42.113B, S42.114A, S42.114B, S42.115A, S42.115B, S42.116A, S42.116B, S42.121A, S42.121B, S42.122A, S42.122B, S42.123A, S42.123B, S42.124A, S42.124B, S42.125A, S42.125B, S42.126A, S42.126B, S42.131A, S42.131B, S42.132A, S42.132B, S42.133A, S42.133B, S42.134A, S42.134B, S42.135A, S42.135B, S42.136A, S42.136B, S42.141A, S42.141B, S42.142A, S42.142B, S42.143A, S42.143B, S42.144A, S42.144B, S42.145A, S42.145B, S42.146A, S42.146B, S42.151A, S42.151B, S42.152A, S42.152B, S42.153A, S42.153B, S42.154A, S42.154B, S42.155A, S42.155B, S42.156A, S42.156B, S42.191A, S42.191B, S42.192A, S42.192B, S42.199A, S42.199B, S42.201A, S42.201B, S42.202A, S42.202B, S42.209A, S42.209B, S42.211A, S42.211B, S42.212A, S42.212B, S42.213A, S42.213B, S42.214A, S42.214B, S42.215A, S42.215B, S42.216A, S42.216B, S42.221A, S42.221B, S42.222A, S42.222B, S42.223A, S42.223B, S42.224A, S42.224B, S42.225A, S42.225B, S42.226A, S42.226B, S42.231A, S42.231B, S42.232A, S42.232B, S42.239A, S42.239B, S42.241A, S42.241B, S42.242A, S42.242B, S42.249A, S42.249B, S42.251A, S42.251B, S42.252A, S42.252B, S42.253A, S42.253B, S42.254A, S42.254B, S42.255A, S42.255B, S42.256A, S42.256B, S42.261A, S42.261B, S42.262A, S42.262B, S42.263A, S42.263B, S42.264A, S42.264B, S42.265A, S42.265B, S42.266A, S42.266B, S42.271A, S42.272A, S42.279A, S42.291A, S42.291B, S42.292A, S42.292B, S42.293A, S42.293B, S42.294A, S42.294B, S42.295A, S42.295B, S42.296A, S42.296B, S42.301A, S42.301B, S42.302A, S42.302B, S42.309A, S42.309B, S42.321A, S42.321B, S42.322A, S42.322B, S42.323A, S42.323B, S42.324A, S42.324B, S42.325A, S42.325B, S42.326A, S42.326B, S42.331A, S42.331B, S42.332A, S42.332B, S42.333A, S42.333B, S42.334A, S42.334B, S42.335A, S42.335B, S42.336A, S42.336B, S42.341A, S42.341B, S42.342A, S42.342B, S42.343A, S42.343B, S42.344A, S42.344B, S42.345A, S42.345B, S42.346A, S42.346B, S42.351A, S42.351B, S42.352A, S42.352B, S42.353A, S42.353B, S42.354A, S42.354B, S42.355A, S42.355B, S42.356A, S42.356B, S42.361A, S42.361B, S42.362A, S42.362B, S42.363A, S42.363B, S42.364A, S42.364B, S42.365A, S42.365B, S42.366A, S42.366B, S42.391A, S42.391B, S42.392A, S42.392B, S42.399A, S42.399B, S42.401A, S42.401B, S42.402A, S42.402B, S42.409A, S42.409B, S42.411A, S42.411B, S42.412A, S42.412B, S42.413A, S42.413B, S42.414A, S42.414B, S42.415A, S42.415B, S42.416A, S42.416B, S42.421A, S42.421B, S42.422A, S42.422B, S42.423A, S42.423B, S42.424A, S42.424B, S42.425A, S42.425B, S42.426A, S42.426B, S42.431A, S42.431B, S42.432A, S42.432B, S42.433A, S42.433B, S42.434A, S42.434B, S42.435A, S42.435B, S42.436A, S42.436B, S42.441A, S42.441B,S42.442A, S42.442B, S42.443A, S42.443B, S42.444A, S42.444B, S42.445A, S42.445B, S42.446A, S42.446B, S42.447A, S42.447B, S42.448A, S42.448B, S42.449A, S42.449B, S42.451A, S42.451B, S42.452A, S42.452B, S42.453A, S42.453B, S42.454A, S42.454B, S42.455A, S42.455B, S42.456A, S42.456B, S42.461A, S42.461B, S42.462A, S42.462B, S42.463A, S42.463B, S42.464A, S42.464B, 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