2025 COLLECTION TYPE:
MIPS CLINICAL QUALITY MEASURES (CQMS)
Description:
Percentage of patients aged 18 years and older diagnosed with epithelial ovarian, fallopian tube, or primary peritoneal cancer who undergo germline testing within 6 months of diagnosis.
Instructions:
This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. This measure is intended to reflect the quality of services provided for patients aged 18 and older newly diagnosed with epithelial ovarian, fallopian tube, or primary peritoneal cancer. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who provide the measure-specific denominator coding.
NOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, POS 02, or POS 10) modifiers are allowable.
Measure Submission Type:
Measure data may be submitted by individual MIPS eligible clinicians, groups, or third-party intermediaries. 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 by MIPS eligible clinicians, groups, or third-party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third-party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.
DENOMINATOR:
All patients aged 18 and older with epithelial ovarian, fallopian tube, or primary peritoneal cancer newly diagnosed between July 1st of the previous performance period through June 30th of the current performance period with two encounters during the performance period
Denominator Instructions:
Patients must receive a new diagnosis for epithelial ovarian, fallopian tube, or primary peritoneal cancer from July 1st of the previous performance period through June 30th of the current performance period to be denominator eligible for this measure. The new diagnosis should be the patient’s initial (first-ever) diagnosis of ovarian, fallopian tube, or primary peritoneal cancer.
The measure further specifies a population of patients with unknown Breast Cancer gene (BRCA) status. The panel acknowledges patients diagnosed with ovarian cancer may have undergone germline testing for a previous breast cancer diagnosis or that patients may have ovarian cancer identified at the time of prophylactic surgery following germline testing; patients with a known BRCA status at the time of ovarian cancer diagnosis are therefore not a population for whom this measure applies.
DENOMINATOR NOTE: The patient must have two encounters during the performance period. This is intended to reflect two separate encounters with the same reporting provider/group during this timeframe. There is no specific timeframe for the requirement for the two encounters that occur during the performance period. For example, two encounters with the same provider/group could occur in the same week. However, two encounters should not be counted if they occur on the same day. For example, the patient has two encounters and one is with a different provider on the same day.
*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 and older on the date of the encounter
AND
Diagnosis for epithelial ovarian, fallopian tube, or primary peritoneal cancer between July 1st of the previous performance period through June 30th of the current performance period (ICD-10-CM): C56.1, C56.2, C56.3, C56.9, C57.00, C57.01, C57.02, C48.1, C48.2, C48.8
AND
Two encounters during the performance period (CPT): 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*
AND NOT
DENOMINATOR EXCLUSION:
Patients who have germline BRCA testing completed before diagnosis of epithelial ovarian, fallopian tube, or primary peritoneal cancer: M1408
Numerator:
Patients who receive germline genetic testing for BRCA1 and BRCA2 (ideally within the context of a multigene panel) or who have genetic counseling completed within 6 months of diagnosis
NUMERATOR NOTE: The American Society of Clinical Oncology (ASCO) guideline panel recommends that germline sequencing of BRCA1 and BRCA2 be performed in the context of a multigene panel that includes BRCA1, BRCA2, RAD51C, RAD51D, BRCA1 Interacting Protein (BRIP1), DNA mismatch repair protein (MLH)1, MSH2, MSH6, PMS2, and Partner and localizer of BRCA2 (PALB2). While the technical expert panel (TEP) prefers germline genetic testing is conducted for other ovarian cancer susceptibility genes in addition to BRCA1 and BRCA2 as recommended in the guideline, this measure focuses specifically on BRCA1 and BRCA2 as there may be payer variation or other limitations in the availability of multigene panels. While the ASCO guideline recommendation calls for germline testing to be conducted at the time of diagnosis, the TEP chose to specify the time period for germline testing to occur within 6 months after diagnosis. Completion of genetic counseling is included in the numerator to account for clinical workflows in practices where BRCA1 and BRCA2 testing is ordered by a genetic counselor rather than the reporting oncologist. Completion of genetic counseling may be signified by the presence of CPT or HCPCS codes (e.g., S0265) or presence of a genetic counseling report. Referral alone to genetic counseling, without evidence the patient completed genetic counseling, does not satisfy the numerator.
The performed/collected date for BRCA testing will be used to calculate the numerator time period.
Numerator Options:
Performance Met: Patients who received germline testing for BRCA1 and BRCA2 or genetic counseling completed within 6 months of diagnosis (M1409)
OR
Performance Not Met: Patients who did not have germline testing for BRCA1 and BRCA2 or genetic counseling completed within 6 months of diagnosis (M1410)
Stay updated with the latest news regarding MACRA and MIPS
The Healthmonix Advisor is a free news source that connects you to the latest in the value-based care industry!