CMS Measure ID: #268
Collection Type: CQM
Reporting Frequency: Once per patient per year
High Priority: No
NQS Domain: Effective Clinical Care
Measure Age: > 2 years
This measure is to be submitted a minimum of once per performance period for patients with a diagnosis of epilepsy 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 (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.
Percentage of all patients of childbearing potential (12 years and older) diagnosed with epilepsy who were counseled at least once a year about how epilepsy and its treatment may affect contraception and pregnancy
2023 Benchmarks (from 2021 CMS data)
Topped out: No
Capped at 7: No
Decile 0: 0 – 1.02
Decile 1: 1.03 – 6.96
Minimum: 6.97 – 10.93
Decile 3: 10.94 – 30.13
Decile 4: 30.14 – 40.9
Decile 5: 40.91 – 55.77
Decile 6: 55.78 – 79.99
Decile 7: 80 – 91.66
Decile 8: 91.67 – 99.37
Decile 9: 99.38 – 99.99
Decile 10: 100 – 100
All females, including all individuals of childbearing potential (12 years and older) with a diagnosis of epilepsy.
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.
Female Unable to Bear Children – For the purposes of this measure, this includes patients who are pre-menstrual, post-menopausal, surgically sterile, or have reproductive organs absent, and is represented by code M1016.
Denominator Criteria (Eligible Cases):
All females age 12 years and older
Diagnosis for Epilepsy (ICD-10-CM): G40.001, G40.009, G40.011, G40.019, G40.101, G40.109, G40.111, G40.119, G40.201, G40.209, G40.211, G40.219, G40.301, G40.309, G40.311, G40.319, G40.401, G40.409, G40.411, G40.419, G40.501, G40.509, G40.801, G40.802, G40.803, G40.804, G40.811, G40.812, G40.813, G40.814, G40.821, G40.822, G40.823, G40.824, G40.901, G40.909, G40.911, G40.919, G40.A01, G40.A09, G40.A11, G40.A19, G40.B01, G40.B09, G40.B11, G40.B19
Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99421, 99422, 99423, 99441, 99442, 99443
Female Patients Unable to Bear Children: M1016
Female patients or caregivers counseled at least once a year about how epilepsy and its treatment may affect contraception and pregnancy
Counseling – Counseling must include a discussion of at least two of the following three counseling topics:
- Need for folic acid supplementation,
- Drug to drug interactions with contraception medication,
- Potential anti-seizure medications effect(s) on fetal/child development and/or pregnancy.
Performance Met: Counseling for women of childbearing potential with epilepsy (4340F)
Performance Not Met: Counseling about epilepsy specific safety issues provided to patient or caregiver was not performed, reason not otherwise specified (4340F with 8P)