CMS Measure ID: #400
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 all patients >= 18 years of age seen during the performance period AND who were seen twice for any visits or who had at least one preventive visit within the 12-month 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.
Percentage of patients age >= 18 years who received one-time screening for hepatitis C virus (HCV) infection.
All patients >= 18 years of age who had at least one preventitive visit OR were seen at least twice 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):
Patients aged ≥ 18 years
At least one preventive encounter during the performance period (CPT or HCPCS): 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, G0438, G0439
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
Diagnosis for Chronic Hepatitis C (ICD-10-CM): B18.2
Patients who received one-time screening for HCV infection
NUMERATOR NOTE: Denominator Exception(s) are determined on the date of the most recent denominator eligible encounter.
Screening for HCV Infection includes current or prior receipt of:
- HCV antibody test
- HCV RNA test
- Recombinant immunoblot assay (RIBA) test (if performed at any time in the past)
Patient received one-time screening for HCV infection (G9451)
Documentation of medical reason(s) for not receiving one-time 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) (G9452)
Documentation of patient reason(s) for not receiving one-time screening for HCV infection (e.g., patient declined, other patient reasons) (G9453)
Performance Not Met:
One-time screening for HCV infection not received within 12 month reporting period and no documentation of prior screening for HCV infection, reason not given (G9454)