CMS Measure ID: #338
Collection Type: CQM
Reporting Frequency: Once per patient per year
Outcome: Yes
High Priority: Yes
NQS Domain: Effective Clinical Care
Measure Age: > 2 years
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.
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
The percentage of patients, regardless of age, with a diagnosis of HIV with a HIV viral load less than 200 copies/mL at last HIV viral load test during the measurement year
2023 Benchmarks (from 2021 CMS data)
Registry
Topped out: No
Capped at 7: No
Decile 0: 0 – 57.31
Decile 1: 57.32 – 81.73
Minimum: 81.74 – 87.32
Decile 3: 87.33 – 91.31
Decile 4: 91.32 – 93.25
Decile 5: 93.26 – 94.49
Decile 6: 94.5 – 95.81
Decile 7: 95.82 – 98.97
Decile 8: 98.98 – 99.99
Decile 10: 100 – 100
Denominator
Patients, regardless of age, with a diagnosis of HIV who had at least one medical visit during the performance 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
Numerator
Number of patients with a HIV viral load less than 200 copies/mL at last viral load test
Numerator Options:
Performance Met:
Documentation of viral load less than 200 copies/mL (G9243)
OR
Performance Not Met:
Documentation of viral load equal to or greater than 200 copies/mL or viral load not performed (G9242)