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2025 MIPS Measure Diabetes: Glycemic Status Assessment Greater Than 9%

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2025 COLLECTION TYPE:

MIPS CLINICAL QUALITY MEASURES (CQMS)

MEASURE TYPE:‌Intermediate Outcome – High Priority

Description:

‌Percentage of patients 18-75 years of age with diabetes who had a glycemic status assessment (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) > 9.0% during the measurement period.

Instructions:

This Measure Is to Be Submitted a Minimum of Once per Performance Period For Patients with Diabetes Seen During the Performance Period. the Most Recent Quality Data Code Submitted Will Be Used for Performance Calculation. 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 (including but Not Limited to Encounters Coded with Gq, Gt, Pos 02, Pos 10) Are Allowable. Please Note that Effective January 1, 2025, While a Measure May Be Denoted as Telehealth Eligible, Specific Denominator Codes Within the Encounter May No Longer Be Eligible Due to Changes Outlined in The Cy 2024 Pfs Final Rule List of Medicare Telehealth Services.

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:

Patients 18 – 75 Years of Age with Diabetes with A Visit During the Measurement Period

Denominator Note: To Assess the Age for Exclusions, the Patient’s Age on The Date of The Encounter Should Be Used.

*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 Cq Ms.

Denominator Criteria (eligible Cases):

Patients 18 Through 75 Years of Age on Date of Encounter

And

Diagnosis for Diabetes (icd-10-Cm): E10.A2, E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.3211, E10.3212, E10.3213, E10.3219, E10.3291, E10.3292, E10.3293, E10.3299, E10.3311, E10.3312, E10.3313, E10.3319, E10.3391, E10.3392, E10.3393, E10.3399, E10.3411, E10.3412, E10.3413, E10.3419, E10.3491, E10.3492, E10.3493, E10.3499, E10.3511, E10.3512, E10.3513, E10.3519, E10.3521, E10.3522, E10.3523, E10.3529, E10.3531, E10.3532, E10.3533, E10.3539, E10.3541, E10.3542, E10.3543, E10.3549, E10.3551, E10.3552, E10.3553, E10.3559, E10.3591, E10.3592, E10.3593, E10.3599, E10.36, E10.37 X1, E10.37 X2, E10.37 X3, E10.37 X9, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.22, E11.29, E11.311, E11.319, E11.3211, E11.3212, E11.3213, E11.3219, E11.3291, E11.3292, E11.3293, E11.3299, E11.3311, E11.3312, E11.3313, E11.3319, E11.3391, E11.3392, E11.3393, E11.3399, E11.3411, E11.3412, E11.3413, E11.3419, E11.3491, E11.3492, E11.3493, E11.3499, E11.3511, E11.3512, E11.3513, E11.3519, E11.3521, E11.3522, E11.3523, E11.3529, E11.3531, E11.3532, E11.3533, E11.3539, E11.3541, E11.3542, E11.3543, E11.3549, E11.3551, E11.3552, E11.3553, E11.3559, E11.3591, E11.3592, E11.3593, E11.3599, E11.36, E11.37 X1, E11.37 X2, E11.37 X3, E11.37 X9, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9, E13.00, E13.01, E13.10, E13.11, E13.21, E13.22, E13.29, E13.311, E13.319, E13.3211, E13.3212, E13.3213, E13.3219, E13.3291, E13.3292, E13.3293, E13.3299, E13.3311, E13.3312, E13.3313, E13.3319, E13.3391, E13.3392, E13.3393, E13.3399, E13.3411, E13.3412, E13.3413, E13.3419, E13.3491, E13.3492, E13.3493, E13.3499, E13.3511, E13.3512, E13.3513, E13.3519, E13.3521, E13.3522, E13.3523, E13.3529, E13.3531, E13.3532, E13.3533, E13.3539, E13.3541, E13.3542, E13.3543, E13.3549, E13.3551, E13.3552, E13.3553, E13.3559, E13.3591, E13.3592, E13.3593, E13.3599, E13.36, E13.37 X1, E13.37 X2, E13.37 X3, E13.37 X9, E13.39, E13.40, E13.41, E13.42, E13.43, E13.44, E13.49, E13.51, E13.52, E13.59, E13.610, E13.618, E13.620, E13.621, E13.622, E13.628, E13.630, E13.638, E13.641, E13.649, E13.65, E13.69, E13.8, E13.9, O24.011, O24.012, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112, O24.113, O24.119, O24.12, O24.13, O24.311, O24.312, O24.313, O24.319, O24.32, O24.33, O24.811, O24.812, O24.813, O24.819, O24.82, O24.83

And

Patient Encounter During Performance Period (cpt or Hcpcs): 97802, 97803, 97804, 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, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, G0270, G0271, G0402, G0438, G0439

And Not

Denominator Exclusions:

Hospice Services Provided to Patient Any Time During the Measurement Period: G9687

Or

Palliative Care Services Provided to Patient Any Time During the Measurement Period: G9988

Or

Patients Age 66 and Older in Institutional Special Needs Plans (snp) or Residing in Long-Term Care with A Pos Code 32, 33, 34, 54 or 56 for More than 90 Consecutive Days During the Measurement Period: G2081

Or

Patients 66 Years of Age and Older with At Least One Claim/encounter for Frailty During the Measurement Period and A Dispensed Medication for Dementia During the Measurement Period or The Year Prior to The Measurement Period: G2090

Or

Patients 66 Years of Age and Older with At Least One Claim/encounter for Frailty During the Measurement Period and An Advanced Illness Diagnosis During the Measurement Period or The Year Prior to The Measurement Period: G2091

Table: Dementia Exclusion Medications

Description Prescription
Cholinesterase inhibitors Donepezil Rivastigimine Galantamine
Miscellaneous central nervous system agents Memantine
Dementia combinations Donepezil- memantine

Codes to Identify Frailty: 99504, 99509, E0100, E0105, E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149, E0163, E0165, E0167, E0168, E0170, E0171, E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0270, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0301, E0302, E0303, E0304, E0424, E0425, E0430, E0431, E0433, E0434, E0435, E0439, E0440, E0441, E0442, E0443, E0444, E0462, E0465, E0466, E0470, E0471, E0472, E0561, E0562, E1130, E1140, E1150, E1160, E1161, E1240, E1250, E1260, E1270, E1280, E1285, E1290, E1295, E1296, E1297, E1298, G0162, G0299, G0300, G0493, G0494, S0271, S0311, S9123, S9124, T1000, T1001, T1002, T1003, T1004, T1005, T1019, T1020, T1021, T1022, T1030, T1031, L89.000, L89.001, L89.002, L89.003, L89.004, L89.006, L89.009, L89.010, L89.011, L89.012, L89.013, L89.014, L89.016, L89.019, L89.020, L89.021, L89.022, L89.023, L89.024, L89.026, L89.029, L89.100, L89.101, L89.102, L89.103, L89.104, L89.106, L89.109, L89.110, L89.111, L89.112, L89.113, L89.114, L89.116, L89.119, L89.120, L89.121, L89.122, L89.123, L89.124, L89.126, L89.129, L89.130, L89.131, L89.132, L89.133, L89.134, L89.136, L89.139, L89.140, L89.141, L89.142, L89.143, L89.144, L89.146, L89.149, L89.150, L89.151, L89.152, L89.153, L89.154, L89.156, L89.159, L89.200, L89.201, L89.202, L89.203, L89.204, L89.206, L89.209, L89.210, L89.211, L89.212, L89.213, L89.214, L89.216, L89.219, L89.220, L89.221, L89.222, L89.223, L89.224, L89.226, L89.229, L89.300, L89.301, L89.302, L89.303, L89.304, L89.306, L89.309, L89.310, L89.311, L89.312, L89.313, L89.314, L89.316, L89.319, L89.320, L89.321, L89.322, L89.323, L89.324, L89.326, L89.329, L89.40, L89.41, L89.42, L89.43, L89.44, L89.45, L89.46, L89.500, L89.501, L89.502, L89.503, L89.504, L89.506, L89.509, L89.510, L89.511, L89.512, L89.513, L89.514, L89.516, L89.519, L89.520, L89.521, L89.522, L89.523, L89.524, L89.526, L89.529, L89.600, L89.601, L89.602, L89.603, L89.604, L89.606, L89.609, L89.610, L89.611, L89.612, L89.613, L89.614, L89.616, L89.619, L89.620, L89.621, L89.622, L89.623, L89.624, L89.626, L89.629, L89.810, L89.811, L89.812, L89.813, L89.814, L89.816, L89.819, L89.890, L89.891, L89.892, L89.893, L89.894, L89.896, L89.899, L89.90, L89.91, L89.92, L89.93, L89.94, L89.95, L89.96, M62.50, M62.81, M62.84, R26.2, R26.89, R26.9, R53.1, R53.81, R54, R62.7, R63.4, R63.6, R64, W01.0 Xxa, W01.0 Xxd, W01.0 Xxs, W01.10 Xa, W01.10 Xd, W01.10 Xs, W01.110 A, W01.110 D, W01.110 S, W01.111 A, W01.111 D, W01.111 S, W01.118 A, W01.118 D, W01.118 S, W01.119 A, W01.119 D, W01.119 S, W01.190 A, W01.190 D, W01.190 S, W01.198 A, W01.198 D, W01.198 S, W06.Xxxa, W06.Xxxd, W06.Xxxs, W07.Xxxa, W07.Xxxd, W07.Xxxs, W08.Xxxa, W08.Xxxd, W08.Xxxs, W10.0 Xxa, W10.0 Xxd, W10.0 Xxs, W10.1 Xxa, W10.1 Xxd, W10.1 Xxs, W10.2 Xxa, W10.2 Xxd, W10.2 Xxs, W10.8 Xxa, W10.8 Xxd, W10.8 Xxs, W10.9 Xxa, W10.9 Xxd, W10.9 Xxs, W18.00 Xa, W18.00 Xd, W18.00 Xs, W18.02 Xa, W18.02 Xd, W18.02 Xs, W18.09 Xa, W18.09 Xd, W18.09 Xs, W18.11 Xa, W18.11 Xd, W18.11 Xs, W18.12 Xa, W18.12 Xd, W18.12 Xs, W18.2 Xxa, W18.2 Xxd, W18.2 Xxs, W18.30 Xa, W18.30 Xd, W18.30 Xs, W18.31 Xa, W18.31 Xd, W18.31 Xs, W18.39 Xa, W18.39 Xd, W18.39 Xs, W19.Xxxa, W19.Xxxd, W19.Xxxs, Y92.199, Z59.3, Z73.6, Z74.01, Z74.09, Z74.1, Z74.2, Z74.3, Z74.8, Z74.9, Z91.81, Z99.11, Z99.3, Z99.81, Z99.89

Codes to Identify Advanced Illness: A81.00, A81.01, A81.09, C25.0, C25.1, C25.2, C25.3, C25.4, C25.7, C25.8, C25.9, C71.0, C71.1, C71.2, C71.3, C71.4, C71.5, C71.6, C71.7, C71.8, C71.9, C77.0, C77.1, C77.2, C77.3, C77.4, C77.5, C77.8, C77.9, C78.00, C78.01, C78.02, C78.1, C78.2, C78.30, C78.39, C78.4, C78.5, C78.6, C78.7, C78.80, C78.89, C79.00, C79.01, C79.02, C79.10, C79.11, C79.19, C79.2, C79.31, C79.32, C79.40, C79.49, C79.51, C79.52, C79.60, C79.61, C79.62, C79.70, C79.71, C79.72, C79.81, C79.82, C79.89, C79.9, C91.00, C91.02, C92.00, C92.02, C93.00, C93.02, C93.90, C93.92, C93.Z0, C93.Z2, C94.30, C94.32, F01.50, F01.511, F01.518, F01.52, F01.53, F01.54, F01.A0, F01.A11, F01.A18, F01.A2, F01.A3, F01.A4, F01.B0, F01.B11, F01.B18, F01.B2, F01.B3, F01.B4, F01.C0, F01.C11, F01.C18, F01.C2, F01.C3, F01.C4, F02.80, F02.811, F02.818, F02.82, F02.83, F02.84, F02.A0, F02.A11, F02.A18, F02.A2, F02.A3, F02.A4, F02.B0, F02.B11, F02.B18, F02.B2, F02.B3, F02.B4, F02.C0, F02.C11, F02.C18, F02.C2, F02.C3, F02.C4, F03.90, F03.911, F03.918, F03.92, F03.93, F03.94, F03.A0, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B0, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C0, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, F04, F10.27, F10.96, F10.97, G10, G12.21,, G20.A1, G20.A2, G20.B1, G20.B2, G20.C, G30.0, G30.1, G30.8, ‌g30.9, G31.01, G31.09, G31.83, G35, I09.81, I11.0, I12.0, I13.0, I13.11, I13.2, I50.1, I50.20, I50.21, I50.22, I50.23, I50.30, I50.31, I50.32, I50.33, I50.40, I50.41, I50.42, I50.43, I50.810, I50.811, I50.812, I50.813, I50.814, I50.82, I50.83, I50.84, I50.89, I50.9, J43.0, J43.1, J43.2, J43.8, J43.9, J68.4, J84.10, J84.112, J84.170, J84.178, J96.10, J96.11, J96.12, J96.20, J96.21, J96.22, J96.90, J96.91, J96.92, J98.2, J98.3, K70.10, K70.11, K70.2, K70.30, K70.31, K70.40, K70.41, K70.9, K74.00, K74.01, K74.02, K74.1, K74.2, K74.4, K74.5, K74.60, K74.69, N18.5, N18.6

Numerator: Patients Whose Most Recent Glycemic Status Assessment (hb A1c or Gmi) (performed During the Measurement Period) Is

> 9.0% or Is Missing, or Was Not Performed During the Measurement Period

Numerator Instructions: Inverse Measure – a Lower Calculated Performance Rate for This Measure Indicates Better Clinical Care or Control. the “performance Not Met” Numerator Option for This Measure Is the Representation of The Better Clinical Quality or Control. Submitting that Numerator Option Will Produce a Performance Rate that Trends Closer to 0%, as Quality Increases. for Inverse Measures, a Rate of 100% Means All of The Denominator Eligible Patients Did Not Receive the Appropriate Care or Were Not in Proper Control.

Patient Is Numerator Compliant if Most Recent Hb A1c or Gmi Level >9%, the Most Recent Hb A1c or Gmi Result Is Missing, or If There Are No Hb A1c or Gmi Tests Performed and Results Documented During the Measurement Period. Ranges and Thresholds Do Not Meet Criteria for This Indicator. a Distinct Numeric Result Is Required for Numerator Compliance. Do Not Include Hb A1c or Gmi Levels Reported by The Patient.

Numerator Note: If Multiple Glycemic Status Assessments Were Recorded for A Single Date, Use the Lowest Result.

Numerator Options:

Performance Met: Most Recent Glycemic Status Assessment (hb A1c or Gmi) Level > 9.0% (M1211)

Or

Performance Met: Glycemic Status Assessment (hb A1c or Gmi) Level Is Missing, or Was Not Performed During the Measurement Period (m1212)

Or

Performance Not Met: Most Recent Glycemic Status Assessment (hb A1c or Gmi) Level < 7.0% (m1371)

Or

Performance Not Met: Most Recent Glycemic Status Assessment (hb A1c or Gmi) Level ≥ 7.0% and < 8.0% (m1372)

Or

Performance Not Met: Most Recent Glycemic Status Assessment (hb A1c or Gmi) Level ≥ 8.0% and ≤ 9.0% (m1373)

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