MIPS Clinical Quality Measures (CQMS)
MEASURE TYPE: Process
Description
Percentage of patients 13 years of age and older with a diagnosis of HIV who had tests for syphilis, gonorrhea, and chlamydia performed within the performance period.
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. 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, 95, POS 02, POS 10) 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 13 years of age and older at the start of the performance period with a diagnosis of HIV before the end of the performance period with an eligible encounter during the performance 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 ≥ 13 years at the start of the performance period
AND
Diagnosis for HIV before the end of the performance period (ICD-10-CM): B20, B97.35, Z21
AND
Patient encounters during the performance period (CPT or HCPCS): 98966, 98967, 98968, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99384*, 99385*, 99386*, 99387*, 99394*, 99395*, 99396*, 99397*, 99429*, 99441, 99442, 99443, G0438, G0439
Numerator
Patients who were tested for each of the following at least once during the performance period: syphilis, gonorrhea, and chlamydia
NUMERATOR NOTE: Submit G9228 when results are documented for all of the 3 screenings.
Numerator Options:
Performance Met: Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings) (G9228)
OR
Performance Not Met: Chlamydia, gonorrhea, and syphilis screening results not documented as performed, reason not given (G9230)
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