2023 # 410 Psoriasis: Clinical Response to Systemic Medications

CMS Measure ID: #410

Collection Type: CQM

Reporting Frequency: Once per patient per year

Outcome: Yes

High Priority: Yes

NQS Domain: Person and Caregiver-Centered Experience Outcomes

Measure Age: > 2 years

Instructions

This measure is to be submitted a minimum of once per performance period for all patients during the performance period. The most recent denominator eligible encounter should be used to determine if the numerator action was performed. 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-based submissions; however, these codes may be submitted for those registries that utilize claims data.

Description

Percentage of psoriasis vulgaris patients receiving systemic medication who meet minimal physician-or patient-reported disease activity levels. It is implied that establishment and maintenance of an established minimum level of disease control as measured by physician-and/or patient-reported outcomes will increase patient satisfaction with and adherence to treatment

2022 Benchmarks (from 2020 CMS data)

Registry

Topped out: No
Capped at 7: No

Minimum: 0 – 58.21
Decile 3: 58.22 – 72.72
Decile 4: 72.73 – 84.67
Decile 5: 84.68 – 91.88
Decile 6: 91.89 – 96.61
Decile 7: 96.62 – 99.99
Decile 10: 100 – 100

Denominator

All patients with a diagnosis of psoriasis vulgaris and treated with a systemic medication

DENOMINATOR NOTE: For this measure, the patient must ONLY be diagnosed with psoriasis vulgaris (L40.0) and no other concurrent psoriasis diagnosis. Therefore, patients meet criteria when they have been diagnosed with psoriasis vulgaris AND are on a systemic medication PRESCRIBED BY THE PROVIDER BEING EVALUATED FOR THE MEASURE.

*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 psoriasis vulgaris (ICD-10-CM): L40.0

AND

Patient encounter during the performance period (CPT or HCPCS):  99202, 99203, 99204,99205, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99424, 99426, G0438, G0439

AND

Patient has been treated with a systemic medication for psoriasis vulgaris: G9764

Examples of Applicable Medications
Brand Name Chemical Name Mechanism Action/ Type of Systemic Indication
Stelara ustekinumab IL-12 and IL-23 inhibitors Psoriasis, Psoriatic arthritis
Cosentyx secukinumab IL-17 inhibitors Psoriasis, Psoriatic arthritis
Siliq brodalumab IL-17 inhibitors Psoriasis
Taltz ixekizumab IL-17 inhibitors Psoriasis, Psoriatic arthritis
Tremfya guselkumab IL-23 inhibitors Psoriasis
Skyrizi risankizumab-rzaa IL-23 inhibitors Psoriasis
Amjevita adalimumab-atto TNF-alpha inhibitors Psoriasis, Psoriatic arthritis
Cimzia certolizumab TNF-alpha inhibitors Psoriatic arthritis
Cyltezo adalimumab-adbm TNF-alpha inhibitors Psoriasis, Psoriatic arthritis
Enbrel etanercept TNF-alpha inhibitors Psoriasis, Psoriatic arthritis
Erelzi etanercept-szzs TNF-alpha inhibitors Psoriasis, Psoriatic arthritis
Humira adalimumab TNF-alpha inhibitors Psoriasis, Psoriatic arthritis
Inflectra infliximab-dyyb TNF-alpha inhibitors Psoriasis, Psoriatic arthritis
Remicade infliximab TNF-alpha inhibitors Psoriasis, Psoriatic arthritis
Renflexis infliximab-abda TNF-alpha inhibitors Psoriasis, Psoriatic arthritis
Simponi and Simponi Aria golimumab TNF-alpha inhibitors Psoriatic arthritis
Rheumatrex methotrexate Blocks dihydrofolate reductase Psoriasis
Trexall methotrexate Blocks dihydrofolate reductase Psoriasis
Xatmep methotrexate Blocks dihydrofolate reductase Psoriasis
Otrexup methotrexate Inhibits dihydrofolic acid reductase Psoriasis
Rasuvo methotrexate Inhibits dihydrofolic acid reductase Psoriasis
Gengraf cyclosporine, modified Blocks lymphocytes (T cells) and lymphokines Psoriasis
Neoral cyclosporine, modified Blocks lymphocytes (T cells) and lymphokines Psoriasis
Sandimmune cyclosporine Blocks lymphocytes (T cells) and lymphokines Psoriasis
Otezla apremilast Blocks phosphodiesterase-4 (PDE4) Psoriasis, Psoriatic arthritis
Soriatane acitretin Unknown; activates retinoid receptors Psoriasis
Ilumya Tildrakizumab Selective (IL)-23p19 inhibitor Psoriasis

Numerator

Patients who have a documented physician global assessment (PGA; 5-point OR 6-point scale), body surface area (BSA), psoriasis area and severity index (PASI) and/or dermatology life quality index (DLQI) that meet any one of the below specified benchmarks

Definition:

Consecutive Months – The consecutive treatment allows gaps in the medication treatment up to a total of 4 weeks during the 6 month period. Gaps can include periods in which the patient is changing or refilling medication, but regardless of the number of gaps, the total cannot be for more than 4 weeks.

Numerator Instructions:
To satisfy this measure, a patient must achieve any ONE of the following:

  • PGA (5-point scale OR 6-point scale) ≤ 2 (clear to mild skin disease)
  • BSA < 3% (mild disease)
  • PASI < 3 (no or minimal disease)
  • DLQI ≤ 5 (no effect or small effect on patient’s quality of life)

NUMERATOR NOTE: For Denominator Exception(s), patients are ineligible for this measure if at the time of encounter there are patient or medical reason(s) for not meeting specified benchmarks (e.g. patient declined change in medication, patient experience adverse effects, etc.) as further specified below.

Numerator Options:

Performance Met:

Psoriasis assessment tool documented meeting any one of the specified benchmarks (e.g., (PGA; 5-point OR 6- point scale), body surface area (BSA), psoriasis area and severity index (PASI) and/or dermatology life quality index (DLQI)) (G9649)

OR

Denominator Exception:

Documentation that the patient declined change in medication or alternative therapies were unavailable, has documented contraindications, or has not been treated with a systemic medication for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by PGA, BSA, PASI, or DLQI (G9765)

OR

Performance Not Met:

Psoriasis assessment tool documented not meeting any one of the specified benchmarks (e.g., (PGA; 5-point OR 6-point scale), body surface area (BSA), psoriasis area and severity index (PASI) and/or dermatology life quality index (DLQI)) or psoriasis assessment tool not documented (G9651)


Tags

CQM-2023