2023 # 293 Rehabilitative Therapy Referral for Patients with Parkinson’s Disease

CMS Measure ID: #293

Collection Type: CQM

Reporting Frequency: Once per patient per year

Outcome: No

High Priority: Yes

NQS Domain: Communication and Care Coordination

Measure Age: > 2 years

Instructions

This measure is to be submitted a minimum of once per performance period for patients with a diagnosis of Parkinson’s disease 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 (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.

Measure Submission Type:

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 for registry submissions; however, these codes may be submitted for those registries that utilize claims data.

Description

Percentage of all patients with a diagnosis of Parkinson’s Disease who were referred to physical, occupational, speech, or recreational therapy once during the measurement period.

2023 Benchmarks (from 2021 CMS data)

Registry

Topped out: No
Capped at 7: No

Decile 0: 0 – 0.78
Decile 1: 0.79 – 17.32
Minimum: 17.33 – 36.83
Decile 3: 36.84 – 68.96
Decile 4: 68.97 – 86.35
Decile 5: 86.36 – 92.95
Decile 6: 92.96 – 98.54
Decile 7: 98.55 – 99.99
Decile 10: 100 – 100

Denominator

All patients with a diagnosis of Parkinson’s disease.

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):

All patients regardless of age

AND

Diagnosis for Parkinson’s disease (ICD-10-CM): G20

AND

Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99421, 99422, 99423, 99441, 99442, 99443, 99483

Numerator

Patients who were referred to physical, occupational, speech, or recreational therapy once during the measurement period

Numerator Options:

Performance Met:

Referral to physical, occupational, speech, or recreational therapy (G0042)

OR

Denominator Exception:

Patient and/or care partner decline referral (G0041)

OR

Denominator Exception:

Clinician determines patient does not require referral (G0038)

OR

Denominator Exception:

Patient already receiving physical/occupational/speech/recreational therapy during the measurement period (G0040)

OR

Performance Not Met:

Patient not referred, reason not otherwise specified (G0039)