Percentage of visits for patients aged 18 years and older with a diagnosis of obstructive sleep apnea who were prescribed positive airway pressure therapy who had documentation that adherence to positive airway pressure therapy was objectively measured
This measure is to be submitted a minimum of once per performance period for patients with sleep apnea seen during the performance period. 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.
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.
All patients aged 18 years and older with a diagnosis of sleep apnea
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
Diagnosis for sleep apnea (ICD-10-CM): G47.30, G47.33
Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350
Telehealth Modifier: GQ, GT, 95, POS 02
Positive airway pressure therapy was prescribed: G8852
Patient visits with documentation that adherence to positive airway pressure therapy was objectively measured
Objectively Measured - is defined as positive airway pressure machine-generated measurement of hours of use.
Performance Met: Objective measurement of adherence to positive airway pressure therapy, documented (G8851)
Denominator Exception: Documentation of reason(s) for not objectively measuring adherence to positive airway pressure therapy (e.g., patient didn’t bring data from continuous positive airway pressure [CPAP], therapy not yet initiated, not available on machine) (G8854)
Performance Not Met: Objective measurement of adherence to positive airway pressure therapy not performed, reason not given (G8855)