MIPS Clinical Quality Measures (CQMS)
Description
Percentage of patients, regardless of age, who are active injection drug users who received screening for HCV infection within the 12-month reporting period.
Instructions
This measure is to be submitted a minimum of once per performance period for all patients, regardless of age, who are active injection drug users 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 (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
All patients, regardless of age, who are seen twice for any visit or who had at least one preventive visit within the 12- month reporting period who are active injection drug users
Definition:
Active injection drug users – Those who have injected any drug(s) 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):
Documentation of active injection drug use: G9518
AND
At least one preventive encounter during the performance period (CPT or HCPCS): 99381*, 99382*, 99383*, 99384*, 99385*, 99386*, 99387*, 99391*, 99392*, 99393*, 99394*, 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 screening for HCV infection within the 12-month reporting period
Definition:
Screening for HCV infection – includes HCV antibody test or HCV RNA test.
NUMERATOR NOTE: Denominator Exception(s) are determined on the date of the most recent denominator eligible encounter.
Numerator Options:
Performance Met: Patient received screening for HCV infection within the 12-month reporting period (G9383)
OR
Denominator Exception: Documentation of medical reason(s) for not receiving annual 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) (G9384)
OR
Denominator Exception: Documentation of patient reason(s) for not receiving annual screening for HCV infection (e.g., patient declined, other patient reasons) (G9385)
OR
Performance Not Met: Screening for HCV infection not received within the 12- month reporting period, reason not given (G9386)
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