|Measure Type||High Priority Measure?||Collection Type(s)|
|Patient Reported Outcome||yes||Medicare Part B Claims, MIPS CQM|
Percentage of patients with a diagnosis of primary headache disorder whose health related quality of life (HRQoL) was assessed with a tool(s) during at least two visits during the 12 month measurement period AND whose health related quality of life score stayed the same or improved
This measure is to be submitted at least once per performance period for patients with a diagnosis of primary headache 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.
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.
All patients with a diagnosis of primary headache disorder
Primary Headache for the purpose of this measure includes the following types of headache:
- Migraine: Migraine without aura, migraine with aura, childhood periodic syndromes that are commonly precursors of migraine, retinal migraine, complications of migraine, probable migraine.
- Tension-Type Headache (TTH): Infrequent episodic TTH, frequent episodic TTH, chronic TTH, probable TTH.
- Cluster Headache (CH) and Other Trigeminal Autonomic Cephalgias: Cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgia form headache attacks with conjunctival injection and tearing (SUNCT), probable trigeminal autonomic cephalgia.
- Other Primary Headaches: Primary stabbing headache, primary cough headache, primary exertional headache, primary headache associated with sexual activity, hypnic headache, primary thunderclap headache, hemicrania continua, new daily-persistent headache.
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):
Diagnosis for Primary Headache (ICD-10-CM): G43.001, G43.009, G43.011, G43.019, G43.101, G43.109, G43.111, G43.119, G43.401, G43.409, G43.411, G43.419, G43.501, G43.509, G43.511, G43.519, G43.601, G43.609, G43.611, G43.619,G43.701, G43.709, G43.711, G43.719, G43.801, G43.809, G43.811, G43.819, G43.821, G43.829, G43.831,G43.839, G43.901, G43.909, G43.911, G43.919, G44.009, G44.019, G44.029, G44.039, G44.049, G44.059, G44.099, G44.1, G44.209, G44.219, G44.221, G44.229, G44.51, G44.52, G44.53, G44.59, G44.81, G44.82, G44.83, G44.84, G44.85, G44.89
Encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*
Telehealth Modifier: GQ, GT, 95, POS 02
At Least Two Visits during the Performance Period
Patient whose health related quality of life was assessed with a tool(s) during at least two visits during the 12 month measurement period AND whose health related quality of life score stayed the same or improved
List quality of life (QoL) tools: Migraine Disability Assessment (MIDAS) and PedMIDAS(proprietary); Headache Impact Test-6 (HIT-6)(proprietary); Migraine Specific Quality of Life Tool (MSQ); Neck Disability Index (NDI)-used for cervicogenic headaches; McGill Questionnaire.
Timing Between Visits: Must be separated by at least 90 days for MIDAS and at least 4 weeks for any other tool.
See specific tools for scoring methods related to improvement or stayed the same: Each tool defines improvement differently based on their scoring methodology. For example, when using the MIDAS improvement would be indicated by reduction in MIDAS disability grade and in the HIT-6 a reduction in the number of days with disability overtime indicates improvement.
NUMERATOR NOTE: The two assessments must be separated by at least 90 days for MIDAS and at least 4 weeks for any other tool. It is expected that the QoL score or ranking will stay the same or improve in order for this measure to be successfully completed. Denominator Exception(s) are determined on the date of the denominator eligible encounter.
Health-related quality of life assessed with tool during at least two visits and quality of life score remained the same or improved (G9634)
Health-related quality of life not assessed with tool for documented reason(s) (e.g., patient has a cognitive or neuropsychiatric impairment that impairs his/her ability to complete the HRQoL survey, patient has the inability to read and/or write in order to complete the HRQoL questionnaire) (G9635)
Performance Not Met:
Health-related quality of life not assessed with tool during at least two visits or quality of life score declined (G9636)