MIPS Clinical Quality Measures (CQMS)
MEASURE TYPE: Process – High Priority
Description
Percentage of patients, regardless of age, with a diagnosis of HIV who had at least one medical visit in each 6-month period of the 24-month measurement period, with a minimum of 60 days between medical visits.
Instructions
This measure is to be submitted a minimum of once per performance period for patients with HIV seen during the performance period. This measure is intended to reflect the quality of services provided for the primary management of patients with HIV. 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 (including but not limited to encounters coded with GQ, GT, 95, POS 02, POS 10) 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, regardless of age, with a diagnosis of HIV with at least one medical visit in the performance period
DENOMINATOR NOTE: In order to determine denominator eligibility, patients should be diagnosed with HIV during the first 3 months of the 24-month measurement period or have a diagnosis prior to the 24- month measurement period. The 24-month measurement period is defined as the 24 months prior to and including the date of the first qualifying encounter during the performance period (i.e., January 1, 2024 through December 31, 2024). Performance of the measure is met when there is at least one medical visit in each 6-month interval with 60 days between denominator eligible encounters for patients with HIV within the 24-month measurement period.
Denominator Criteria (Eligible Cases):
Patients, regardless of age
AND
Diagnosis of HIV (ICD-10-CM): B20, Z21
AND
Patient encounter during the performance period (CPT or HCPCS): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99424, 99426, G0402
AND NOT
DENOMINATOR EXCLUSION:
Patient died at any time during the 24‐month measurement period: G9751
Numerator
Number of patients who had at least one medical visit in each 6-month period of the 24-month measurement period, with a minimum of 60 days between medical visits
Numerator Options:
Performance Met: Patient had at least one medical visit in each 6- month period of the 24-month measurement period, with a minimum of 60 days between medical visits (G9247)
OR
Performance Not Met: Patient did not have at least one medical visit in each 6- month period of the 24-month measurement period, with a minimum of 60 days between medical visits (G9246)
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