2024 MIPS Measure #400: One-Time Screening for Hepatitis C Virus (HCV) and Treatment Initiation

2024 COLLECTION TYPE:

MIPS Clinical Quality Measures (CQMS)

‌MEASURE TYPE: Process

Description

‌Percentage of patients aged ≥ 18 years who have never been tested for Hepatitis C Virus (HCV) infection who receive an HCV infection test AND who have treatment initiated within three months or who are referred to a clinician who treats HCV infection within one month if tested positive for HCV.

‌Instructions

This measure is to be submitted a minimum of once per performance period for all patients aged ≥18 years AND who were seen twice for any visits or who had at least one preventive visit through September 30 of the performance period AND who have never received an HCV antibody test. 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.

This measure will be calculated with 2 performance rates:

1. Percentage of patients aged ≥ 18 years who have never been tested for HCV antibodies and who receive an HCV antibody test.
2. Percentage of patients aged ≥ 18 years who have a reactive HCV antibody test, who have a follow up HCV viral test, and if HCV viremia is detected, have treatment initiated within three months or are referred to a clinician who treats HCV infection within one month of the reactive HCV antibody test.

The denominator of Submission Criteria 2 is a subset of the resulting numerator for Submission Criteria 1, as Submission Criteria 2 is limited to assessing if patients who have a reactive HCV antibody test, have a follow up HCV viral test, and if HCV viremia is detected, treatment is initiated within three months or they are referred to a clinician who treats HCV infection within one month of the reactive HCV antibody test. For all patients aged ≥ 18 years who have never been tested for HCV antibodies, Submission Criteria 1 is applicable, but Submission Criteria 2 will only be applicable for those patients who have a reactive HCV antibody test.

A simple average, which is the sum of the performance rates divided by the number of the performance rates will be used to calculate performance.

NOTE: Include only eligible encounters and HCV antibody test results documented through September 30 of the performance period. This will allow the evaluation of at least 90 days for treatment initiation or documentation of referral made within the performance period.

‌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.

There are two Submission Criteria for this measure:

1. All patients aged ≥ 18 years who have never been tested for HCV antibodies and who receive an HCV antibody test.

   AND

2. All patients aged ≥ 18 years who have a reactive (positive) HCV antibody test and have a follow up HCV viral test, and if HCV viremia is detected, have treatment initiated within three months or are referred to a clinician who treats HCV infection within one month of the reactive HCV antibody test.

‌This measure contains two submission criteria that aim to identify patients who are tested for HCV antibodies (Submission Criteria 1) and patients who have a reactive HCV antibody test and who have a follow up HCV viral test, and if HCV viremia is detected, have treatment initiated within three months or are referred to a clinician who treats HCV infection within one month of the reactive HCV antibody test (Submission Criteria 2). By separating this measure into various submission criteria, the MIPS eligible clinician will be able to better ascertain where gaps in performance exist and identify opportunities for improvement.

Submission Criteria 1

Patients who have never been test for HCV antibodies and who recieve an HCV antibody test

‌Denominator (Submission Criteria 1):

All patients aged ≥ 18 years who are seen twice for any visits or who have at least one preventive visit between January 1 and September 30 of 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 ≥ 18 years

AND

At least one preventive encounter (CPT or HCPCS): 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, G0438, G0439

OR

At least two patient encounters (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

AND NOT

Denominator Exclusions:

Diagnosis for Chronic Hepatitis C (ICD-10-CM): B18.2

OR

Documentation or patient report of HCV antibody test or HCV RNA test which occurred prior to the performance period: M1235

DENOMINATOR NOTE: Either documentation of the prior HCV antibody test or HCV RNA test in the medical record or patient self-report of prior HCV antibody test or HCV RNA test is acceptable for this exclusion

Numerator (Submission Criteria 1):

Patients who receive an HCV antibody test between January 1 and September 30 of the performance period

NUMERATOR NOTE: Denominator Exception(s) are determined on the date of the most recent denominator eligible encounter.

Numerator Options:

Performance Met: Patient receives HCV antibody test with nonreactive result (M1231)

OR

Performance Met: Patient receives HCV antibody test with reactive result (M1232)

OR

Denominator Exception: Documentation of medical reason(s) for not receiving HCV antibody test due to limited life expectancy (G9452)

OR

Performance Not Met: Patient does not receive HCV antibody test OR patient does receive HCV antibody test but results not documented, reason not given (M1233)

Submission Criteria 2:

Patients who receive a reactive (Positive) HCV antibody test with a follow up HCV viral test, and if HCV Viremia is detected, treatment is initiated within three months or receives referral to a clinician who treats HCV infection within one month of the reactive HCV antibody test.‌

Denominator (Submission Criteria 2):

Patients aged ≥ 18 years who are seen twice for any visits OR who have at least one preventive visit AND have documentation of a reactive HCV antibody test between January 1 and September 30 of 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 ≥ 18 years

AND

All eligible instances when M1232 is submitted for Performance Met (patient receives HCV antibody test and the test is reactive) in the numerator of Submission Criteria 1

AND

At least one preventive encounter (CPT or HCPCS): 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, G0438, G0439

OR

At least two patient encounters (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

Numerator (Submission Criteria 2):

Patients who have an HCV viral test conducted that (a) does not detect HCV viremia, or (b) detects HCV viremia and treatment is initiated within three months or they are referred to a clinician who treats HCV infection within one month of the reactive HCV antibody test

Definitions:

Examples of clinicians who treat HCV infection include but are not limited to:

• Gastroenterologist
• Hepatologist
• Infectious disease clinicians

Initiation of treatment definition for clinicians who do not refer patients to specialists for care – Initiation of antiviral treatment, as appropriate, based on clinical guideline recommendations and patient characteristics.

HCV viral test – is defined as a test measuring an established marker of active HCV infection, including:

• HCV RNA test
• HCV core antigen test

Numerator Options:

Performance Met: Patient, who has a reactive HCV antibody test, and has a follow up HCV viral test that detected HCV viremia, is referred within 1 month of the reactive HCV antibody test to a clinician who treats HCV infection (M1229)

OR

Performance Met: Patient, who has a reactive HCV antibody test, and has a follow up HCV viral test that detected HCV viremia, has HCV treatment initiated within 3 months of the reactive HCV antibody test (M1228)

OR

Performance Met: Patient has a reactive HCV antibody test, and has a follow up HCV viral test that does not detect HCV viremia (M1234)

OR

Performance Not Met: Patient has a reactive HCV antibody test and does not have a follow up HCV viral test, OR Patient has a reactive HCV antibody test and has a follow up HCV viral test that detects HCV viremia and is not referred to a clinician who treats HCV infection within 1 month and does not have HCV treatment initiated within 3 months of the reactive HCV antibody test, reason not given (M1230)