Measure Description
The percentage of children screened for risk of developmental, behavioral and social delays using a standardized screening tool in the 12 months preceding or on their first, second, or third birthday. This is a composite measure of screening in the first three years of life that includes three, age-specific indicators assessing whether children are screened in the 12 months preceding or on their first, second or third birthday
Instructions
This measure is to be submitted at least once per performance period for patients seen during the performance period. There is no diagnosis associated with this measure. 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. Merit-based Incentive Payment System (MIPS) eligible clinicians should continue to submit the measure as specified, with no additional steps needed to account for multiple performance rates.
This measure will be calculated with 4 performance rates:
1) Percentage of children who turned 1 during the performance period who were screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report within 12 months preceding or on their birthday
2) Percentage of children who turned 2 during the performance period who were screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report within 12 months preceding or on their birthday
3) Percentage of children who turned 3 during the performance period who were screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report within 12 months preceding or on their birthday
4) Percentage of children who turned 1, 2, or 3 during the performance period who were screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report within 12 months preceding or on their birthday
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 THREE SUBMISSION CRITERIA FOR THIS MEASURE:
1) Children who turned 1 during the performance period (Birth to 1 year of age)
OR
2) Children who turned 2 during the performance period (> 1 year to 2 years of age)
OR
3) Children who turned 3 during the performance period (> 2 years to 3 years of age)
Denominator
All patients who turn 1, 2 or 3 years of age between January 1 and December 31 of the performance period.
Denominator Criteria (Eligible Cases):
SUBMISSION CRITERIA 1: Children who turned 1 during the performance period (Birth to 1 year of age)
SUBMISSION CRITERIA 2: Children who turned 2 during the performance period (> 1 year to 2 years of age)
SUBMISSION CRITERIA 3: Children who turned 3 during the performance period (> 2 years to 3 years of age)
AND
Patient encounter during the performance period (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215
WITHOUT
Telehealth Modifier: GQ, GT, 95, POS 02
Numerator (Submission Criteria 1 & 2 & 3)
Children who were screened for risk of developmental, behavioral and social delays using a standardized tool.
Definitions:
Medical Record Review – Children who had documentation in the medical record of screening for developmental, behavioral and social delays using a validated standardized tool as defined within the measure specification in the 12 months preceding or on their birthday. Documentation must include a note indicating which standardized tool was used, the date of screening, and evidence that the tool was completed and scored.
Standardized Tool – Are tools that have been normed and validated and must meet the following criteria:
1. Developmental domains: The following domains must be included in the standardized developmental screening tool: motor, language, cognitive, and social-emotional.
2. Established Reliability: Reliability scores of approximately 0.70 or above.
3. Established Findings Regarding the Validity: Validity scores for the tool must be approximately 0.70 or above. Measures of validity must be conducted on a significant number of children and using an appropriate standardized developmental or social-emotional assessment instrument(s).
4. Established Sensitivity/Specificity: Sensitivity and specificity scores of approximately 0.70 or above.
Examples of standardized screening tools for developmental, behavioral and social delays that meet the above criteria include, but are not limited to:
• Ages and Stages Questionnaire (ASQ) - 2 months to 5 years
• Ages and Stages Questionnaire - 3rd Edition (ASQ-3)
• Battelle Developmental Inventory Screening Tool (BDI-ST) – Birth to 95 months
• Bayley Infant Neuro-developmental Screen (BINS) - 3 months to 2 years
• Brigance Screens-II – Birth to 90 months
• Child Development Inventory (CDI) - 18 months to 6 years
• Infant Development Inventory – Birth to 18 months
• Parents’ Evaluation of Developmental Status (PEDS) – Birth to 8 years
• Parent’s Evaluation of Developmental Status - Developmental Milestones (PEDS-DM)
The tools listed above are not specific recommendations for tools but are examples of tools cited in Bright Futures that have met the above criteria. Bright Futures cites the 2006 statement on Developmental Screening by the American Academy of Pediatrics. New and updated recommendations are anticipated and may include additional tools that meet these criteria. In addition, new tools meeting these criteria may be developed and may be included in future versions of Bright Futures.
Numerator Instructions:
For the purposes of submitting this measure:
For those third party intermediaries that utilize Medicare Part B claims data, the Performance Met Numerator Option G9966 or equivalent can be submitted if CPT code 96110 (Developmental testing, with interpretation and report) is submitted within the 12 months preceding or on the patient’s birthday during the age stratified episode of care (e.g., children who turn 12 months of age, 24 months of age and 36 months of age during the performance period). The submission of the CPT 96110 code and documentation of the denominator eligible patient encounter do not need to occur simultaneously.
The Performance Met Numerator Option G9966 or equivalent can be submitted if the equivalent documentation of a global developmental screening utilizing a standardized tool as defined below within the medical record review and standardized tool definitions are contained in the patient’s medical record within the 12 months preceding or on the patient’s birthday during the age stratified episode of care (e.g., children who turn 12 months of age, 24 months of age and 36 months of age during the performance period). This measure is anchored to standardized global developmental screening tools that meet four criteria specified below in the Standard Tool definition that identify risk for developmental, behavioral, and social delays.
The Performance Not Met Numerator Option G9967 should be submitted when utilizing CPT Codes 96111, 96127, standardized screening utilizing the ASQ-SE tool, autism M-CHAT tool or when using standardized development screening tools that are specifically focused on one domain of development (e.g., child’s socio-emotional development or autism).
If the MIPS eligible clinician is unable to determine if the documented screening tool meets the Standard Tool definition than submit the Performance Not Met Numerator Option G9967.
Numerator Options:
Performance Met: Children who were screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report (G9966)
OR
Performance Not Met: Children who were not screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report (G9967)