High Priority MeasureNo
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
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.
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
Diagnosis for multiple myeloma – not in remission (ICD-10-CM): C90.00, C90.02
Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*
Telehealth Modifier: GQ, GT, 95, POS 02
Patients who were prescribed or received intravenous bisphosphonate therapy within the 12-month reporting period
NUMERATOR NOTE: In the event that a patient with multiple myeloma is prescribed or is receiving an alternate treatment (e.g., denosumab or other anti-resorptive agents) for a medical reason, submit CPT category II code 4100F-1P. Denominator Exception(s) are determined on the date of the denominator eligible encounter.
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.
Performance Met: Bisphosphonate therapy, intravenous, ordered or received (4100F)
Denominator Exception: Documentation of medical reason(s) for not prescribing bisphosphonates (e.g., patients who do not have bone disease, patients with dental disease, patients with renal insufficiency) (4100F with 1P)
Denominator Exception: Documentation of patient reason(s) for not prescribing bisphosphonates (4100F with 2P)
Performance Not Met: Bisphosphonate therapy, intravenous, not ordered or received, reason not otherwise specified (4100F with 8P)
Multiple myeloma is a disease characterized by bone destruction, in the form of diffuse osteopenia and/or osteolytic lesions, which develop in a significant number of patients. Bisphosphonates can inhibit bone resorption by reducing the number and activity of osteoclasts.
Bisphosphonates have played an important palliative role in the care of patients with multiple myeloma. Use of these agents has demonstrated benefit in reducing painful bony complications.
Clinical Recommendation Statements
The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines:
Bony manifestations of myeloma, in the form of diffuse osteopenia and/or osteolytic lesions, develop in 85% of patients. Related complications are the major cause of limitations in quality of life and performance status in patients with MM. (NCCN, 2018)
A recent meta-analysis of 20 randomized controlled trials of comparing bisphosphonates with either placebo or a different bisphosphonate as a comparator concluded that adding bisphosphonates to the treatment of MM reduces vertebral fractures and probably reduces pain. (NCCN, 2018)
The NCCN Guidelines for Multiple Myeloma recommend bisphosphonates for all patients receiving myeloma therapy for symptomatic disease regardless of documented bone disease. (Category 1 Recommendation) (NCCN, 2018)
In patients with smoldering or stage I MM, according to the NCCN Panel, bisphosphonates may be considered but preferably in a clinical trial. (Category 2A Recommendation) (NCCN, 2018)
The Expert Panel supports starting intravenous bisphosphonates in patients with multiple myeloma with osteopenia (osteoporosis), but no radiographic evidence of lytic bone disease. (ASCO, 2018)
For those patients for whom bisphosphonates were withdrawn after 2 years, the drug should be resumed upon relapse with new-onset skeletal-related events. (ASCO, 2018)