2023 # 338 HIV Viral Load Suppression

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

2022 Benchmarks (from 2020 CMS data)

Registry

Topped out: No
Capped at 7: No

Minimum: 0 – 76.59
Decile 3: 76.6 – 84.71
Decile 4: 84.72 – 88.05
Decile 5: 88.06 – 91.64
Decile 6: 91.65 – 93.72
Decile 7: 93.73 – 98.03
Decile 8: 98.04 – 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)


Tags

CQM-2023