Measure Description
Percentage of patients aged 18 years and older with a diagnosis of multiple myeloma, not in remission, who were prescribed or received intravenous bisphosphonate therapy within the 12-month reporting period
Instructions
This measure is to be submitted a minimum of once per performance period for all multiple myeloma (not in remission) patients seen during the performance period. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who provide services for the patients with the diagnosis of multiple myeloma (not in remission) will submit this measure.
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 years and older with a diagnosis of multiple myeloma, not in remission
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 on date of encounter
AND
Diagnosis for multiple myeloma – not in remission (ICD-10-CM): C90.00, C90.02
AND
Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*
WITHOUT
Telehealth Modifier: GQ, GT, 95, POS 02
Numerator
Patients who were prescribed or received intravenous bisphosphonate therapy within the 12-month reporting period
NUMERATOR NOTE: Denominator Exception(s) are determined on the date of the denominator eligible encounter.
Definitions:
Bisphosphonate Therapy – Includes the following medications: pamidronate and zoledronate.
Prescribed – Includes patients who are currently receiving medication(s) that follow the treatment plan recommended at an encounter during the performance period, even if the prescription for that medication was ordered prior to the encounter.
Numerator Options:
Performance Met: Bisphosphonate therapy, intravenous, ordered or received (4100F)
OR
Denominator Exception: Documentation of medical reason(s) for not prescribing bisphosphonates (eg, patients who do not have bone disease, patients with dental disease, patients with renal insufficiency) (4100F with 1P)
OR
Denominator Exception: Documentation of patient reason(s) for not prescribing bisphosphonates (4100F with 2P)
OR
Performance Not Met: Bisphosphonate therapy, intravenous, not ordered or received, reason not otherwise specified (4100F with 8P)