2024 MIPS Measure #418: Osteoporosis Management in Women Who Had a Fracture

Quality ID 418

NQF 0053

High Priority Measure No

Specifications Registry

Measure Type Process

Registry Link Registry

Specialty Endocrinology Family Medicine Internal Medicine Obstetrics/Gynecology Orthopedic Surgery

Measure Description

The percentage of women 50-85 years of age who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat osteoporosis in the six months after the fracture.

Instructions

This measure is to be submitted after each occurrence of a fracture during the six months prior to the performance period through June 30 of the performance period. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who treat any fracture except fractures of the finger, toe, face or skull will submit this measure. Each occurrence of a fracture is identified by either an ICD-10-CM diagnosis code for fracture and a CPT service code OR an ICD-10-CM diagnosis code for a fracture and a CPT procedure code for surgical treatment of fractures.

NOTE: Patients with any fracture except fractures of the finger, toe, face or skull should have a bone mineral density (BMD) measurement performed or pharmacologic therapy prescribed. The management (BMD performed or pharmacologic therapy prescribed) should occur within six months of the fracture. If multiple fractures occurring on the same date of service are submitted on the same claim form, only one instance of submission will be counted. Claims data will be analyzed to determine unique occurrences. Patients already receiving pharmacologic therapy would automatically meet the intent of this measure.

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.

The intent of the exclusion for individuals age 66 and older residing in long-term care facilities, including nursing homes, is to exclude individuals who may have limited life expectancy and increased frailty where the benefit of the process may not exceed the risks. This exclusion is not intended as a clinical recommendation regarding whether the measures process is inappropriate for specific populations, instead the exclusions allows clinicians to engage in shared decision making with patients about the benefits and risks of screening when an individual has limited life expectancy.

Denominator

Women who experienced a fracture, except fractures of the finger, toe, face or skull, during the six months prior to the performance period through June 30 of the performance period

DENOMINATOR NOTE: To assess the age for exclusions, the patient’s age on the date of the encounter should be used. *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.

Option 1 - Denominator Criteria (Eligible Cases):

Patients aged 50-85 years on date of encounter

AND

Diagnosis for any fracture except fractures of the finger, toe, face or skull (ICD-10-CM): M48.40XA, M48.41XA, M48.42XA, M48.43XA, M48.44XA, M48.45XA, M48.46XA, M48.47XA, M48.48XA, M80.00XA, M80.011A, M80.012A, M80.019A, M80.021A, M80.022A, M80.029A, M80.031A, M80.032A, M80.039A, M80.041A, M80.042A, M80.049A, M80.051A, M80.052A, M80.059A, M80.061A, M80.062A, M80.069A, M80.071A, M80.072A, M80.079A, M80.08XA, M80.80XA, M80.811A, M80.812A, M80.819A, M80.821A, M80.822A, M80.829A, M80.831A, M80.832A, M80.839A, M80.841A, M80.842A, M80.849A, M80.851A, M80.852A, M80.859A, M80.861A, M80.862A, M80.869A, M80.871A, M80.872A, M80.879A, M80.88XA, M80.0AXA, M80.0B1A, M80.0B1D, M80.0B1G, M80.0B1K, M80.0B1P, M80.0B1S, M80.0B2A, M80.0B2D, M80.0B2G, M80.0B2K, M80.0B2P, M80.0B2S, M80.0B9A, M80.0B9D, M80.0B9G, M80.0B9K, M80.0B9P, M80.0B9S, M80.8AXA, M80.8B1A, M80.8B1D, M80.8B1G, M80.8B1K, M80.8B1P, M80.8B1S, M80.8B2A, M80.8B2D, M80.8B2G, M80.8B2K, M80.8B2P, M80.8B2S, M80.8B9A, M80.8B9D, M80.8B9G, M80.8B9K, M80.8B9P, M80.8B9S, M84.311A, M84.312A, M84.319A, M84.321A, M84.322A, M84.329A, M84.331A, M84.332A, M84.333A, M84.334A, M84.339A, M84.341A, M84.342A, M84.343A, M84.350A, M84.351A, M84.352A, M84.353A, M84.359A, M84.361A, M84.362A, M84.363A, M84.364A, M84.369A, M84.371A, M84.372A, M84.373A, M84.374A, M84.375A, M84.376A, M84.38XA, M84.750A, M84.751A, M84.752A, M84.753A, M84.754A, M84.755A, M84.756A, M84.757A, M84.759A, M97.01XA, M97.02XA, M97.11XA, M97.12XA, M97.21XA, M97.22XA, M97.31XA, M97.32XA, M97.41XA, M97.42XA, S12.000A, S12.000B, S12.001A, S12.001B, S12.01XA, S12.01XB, S12.02XA, S12.02XB, S12.030A, S12.030B, S12.031A, S12.031B, S12.040A, S12.040B, S12.041A, S12.041B, S12.090A, S12.090B, S12.091A, S12.091B, S12.100A, S12.100B, S12.101A, S12.101B, S12.110A, S12.110B, S12.111A, S12.111B, S12.112A, S12.112B, S12.120A, S12.120B, S12.121A, S12.121B, S12.130A, S12.130B, S12.131A, S12.131B, S12.14XA, S12.14XB, S12.150A, S12.150B, S12.151A, S12.151B, S12.190A, S12.190B, S12.191A, S12.191B, S12.200A, S12.200B, S12.201A, S12.201B, S12.230A, S12.230B, S12.231A, S12.231B, S12.24XA, S12.24XB, S12.250A, S12.250B, S12.251A, S12.251B, S12.290A, S12.290B, S12.291A, S12.291B, S12.300A, S12.300B, S12.301A, S12.301B, S12.330A, S12.330B, S12.331A, S12.331B, S12.34XA, S12.34XB, S12.350A, S12.350B, S12.351A, S12.351B, S12.390A, S12.390B, S12.391A, S12.391B, S12.400A, S12.400B, S12.401A, S12.401B, S12.430A, S12.430B, S12.431A, S12.431B, S12.44XA, S12.44XB, S12.450A, S12.450B, S12.451A, S12.451B, S12.490A, S12.490B, S12.491A, S12.491B, S12.500A, S12.500B, S12.501A, S12.501B, S12.530A, S12.530B, S12.531A, S12.531B, S12.54XA, S12.54XB, S12.550A, S12.550B, S12.551A, S12.551B, S12.590A, S12.590B, S12.591A, S12.591B, S12.600A, S12.600B, S12.601A, S12.601B, S12.630A, S12.630B, S12.631A, S12.631B, S12.64XA, S12.64XB, S12.650A, S12.650B, S12.651A, S12.651B, S12.690A, S12.690B, S12.691A, S12.691B, S12.8XXA, S12.9XXA, S22.000A, S22.000B, S22.001A, S22.001B, S22.002A, S22.002B, S22.008A, S22.008B, S22.009A, S22.009B, S22.010A, S22.010B, S22.011A, S22.011B, S22.012A, S22.012B, S22.018A, S22.018B, S22.019A, S22.019B, S22.020A, S22.020B, S22.021A, S22.021B, S22.022A, S22.022B, S22.028A, S22.028B, S22.029A, S22.029B, S22.030A, S22.030B, S22.031A, S22.031B, S22.032A, S22.032B, S22.038A, S22.038B, S22.039A, S22.039B, S22.040A, S22.040B, S22.041A, S22.041B, S22.042A, S22.042B, S22.048A, S22.048B, S22.049A, S22.049B, S22.050A, S22.050B, S22.051A, S22.051B, S22.052A, S22.052B, S22.058A, S22.058B, S22.059A, S22.059B, S22.060A, S22.060B, S22.061A, S22.061B, S22.062A, S22.062B, S22.068A, S22.068B, S22.069A, S22.069B, S22.070A, S22.070B, S22.071A, S22.071B, S22.072A, S22.072B, S22.078A, S22.078B, S22.079A, S22.079B, S22.080A, S22.080B, S22.081A, S22.081B, S22.082A, S22.082B, S22.088A, S22.088B, S22.089A, S22.089B, S22.20XA, S22.20XB, S22.21XA, S22.21XB, S22.22XA, S22.22XB, S22.23XA, S22.23XB, S22.24XA, S22.24XB, S22.31XA, S22.31XB, S22.32XA, S22.32XB, S22.39XA, S22.39XB, S22.41XA, S22.41XB, S22.42XA, S22.42XB, S22.43XA, S22.43XB, S22.49XA, S22.49XB, S22.5XXA, S22.5XXB, S22.9XXA, S22.9XXB, S32.000A, S32.000B, S32.001A, S32.001B, S32.002A, S32.002B, S32.008A, S32.008B, S32.009A, S32.009B, S32.010A, S32.010B, S32.011A, S32.011B, S32.012A, S32.012B, S32.018A, S32.018B, S32.019A, S32.019B, S32.020A, S32.020B, S32.021A, S32.021B, S32.022A, S32.022B, S32.028A, S32.028B, S32.029A, S32.029B, S32.030A, S32.030B, S32.031A, S32.031B, S32.032A, S32.032B, S32.038A, S32.038B, S32.039A, S32.039B, S32.040A, S32.040B, S32.041A, S32.041B, S32.042A, S32.042B, S32.048A, S32.048B, S32.049A, S32.049B, S32.050A, S32.050B, S32.051A, S32.051B, S32.052A, S32.052B, S32.058A, S32.058B, S32.059A, S32.059B, S32.10XA, S32.10XB, S32.110A, S32.110B, S32.111A, S32.111B, S32.112A, S32.112B, S32.119A, S32.119B, S32.120A, S32.120B, S32.121A, S32.121B, S32.122A, S32.122B, S32.129A, S32.129B, S32.130A, S32.130B, S32.131A, S32.131B, S32.132A, S32.132B, S32.139A, S32.139B, S32.14XA, S32.14XB, S32.15XA, S32.15XB, S32.16XA, S32.16XB, S32.17XA, S32.17XB, S32.19XA, S32.19XB, S32.2XXA, S32.2XXB, S32.301A, S32.301B, S32.302A, S32.302B, S32.309A, S32.309B, S32.311A, S32.311B, S32.312A, S32.312B, S32.313A, S32.313B, S32.314A, S32.314B, S32.315A, S32.315B, S32.316A, S32.316B, S32.391A, S32.391B, S32.392A, S32.392B, S32.399A, S32.399B, S32.401A, S32.401B, S32.402A, S32.402B, S32.409A, S32.409B, S32.411A, S32.411B, S32.412A, S32.412B, S32.413A, S32.413B, S32.414A, S32.414B, S32.415A, S32.415B, S32.416A, S32.416B, S32.421A, S32.421B, S32.422A, S32.422B, S32.423A, S32.423B, S32.424A, S32.424B, S32.425A, S32.425B, S32.426A, S32.426B, S32.431A, S32.431B, S32.432A, S32.432B, S32.433A, S32.433B, S32.434A, S32.434B, S32.435A, S32.435B, S32.436A, S32.436B, S32.441A, S32.441B, S32.442A, S32.442B, S32.443A, S32.443B, S32.444A, S32.444B, S32.445A, S32.445B, S32.446A, S32.446B, S32.451A, S32.451B, S32.452A, S32.452B, S32.453A, S32.453B, S32.454A, S32.454B, S32.455A, S32.455B, S32.456A, S32.456B, S32.461A, S32.461B, S32.462A, S32.462B, S32.463A, S32.463B, S32.464A, S32.464B, S32.465A, S32.465B, S32.466A, S32.466B, S32.471A, S32.471B, S32.472A, S32.472B, S32.473A, S32.473B, S32.474A, S32.474B, S32.475A, S32.475B, S32.476A, S32.476B, S32.481A, S32.481B, S32.482A, S32.482B, S32.483A, S32.483B, S32.484A, S32.484B, S32.485A, S32.485B, S32.486A, S32.486B, S32.491A, S32.491B, S32.492A, S32.492B, S32.499A, S32.499B, S32.501A, S32.501B, S32.502A, S32.502B, S32.509A, S32.509B, S32.511A, S32.511B, S32.512A, S32.512B, S32.519A, S32.519B, S32.591A, S32.591B, S32.592A, S32.592B, S32.599A, S32.599B, S32.601A, S32.601B, S32.602A, S32.602B, S32.609A, S32.609B, S32.611A, S32.611B, S32.612A, S32.612B, S32.613A, S32.613B, S32.614A, S32.614B, S32.615A, S32.615B, S32.616A, S32.616B, S32.691A, S32.691B, S32.692A, S32.692B, S32.699A, S32.699B, S32.810A, S32.810B, S32.811A, S32.811B, S32.82XA, S32.82XB, S32.89XA, S32.89XB, S32.9XXA, S32.9XXB, S42.001A, S42.001B, S42.002A, S42.002B, S42.009A, S42.009B, S42.011A, S42.011B, S42.012A, S42.012B, S42.013A, S42.013B, S42.014A, S42.014B, S42.015A, S42.015B, S42.016A, S42.016B, S42.017A, S42.017B, S42.018A, S42.018B, S42.019A, S42.019B, S42.021A, S42.021B, S42.022A, S42.022B, S42.023A, S42.023B, S42.024A, S42.024B, S42.025A, S42.025B, S42.026A, S42.026B, S42.031A, S42.031B, S42.032A, S42.032B, S42.033A, S42.033B, S42.034A, S42.034B, S42.035A, S42.035B, S42.036A, S42.036B, S42.101A, S42.101B, S42.102A, S42.102B, S42.109A, S42.109B, S42.111A, S42.111B, S42.112A, S42.112B, S42.113A, S42.113B, S42.114A, S42.114B, S42.115A, S42.115B, S42.116A, S42.116B, S42.121A, S42.121B, S42.122A, S42.122B, S42.123A, S42.123B, S42.124A, S42.124B, S42.125A, S42.125B, S42.126A, S42.126B, S42.131A, S42.131B, S42.132A, S42.132B, S42.133A, S42.133B, S42.134A, S42.134B, S42.135A, S42.135B, S42.136A, S42.136B, S42.141A, S42.141B, S42.142A, S42.142B, S42.143A, S42.143B, S42.144A, S42.144B, S42.145A, S42.145B, S42.146A, S42.146B, S42.151A, S42.151B, S42.152A, S42.152B, S42.153A, S42.153B, S42.154A, S42.154B, S42.155A, S42.155B, S42.156A, S42.156B, S42.191A, S42.191B, S42.192A, S42.192B, S42.199A, S42.199B, S42.201A, S42.201B, S42.202A, S42.202B, S42.209A, S42.209B, S42.211A, S42.211B, S42.212A, S42.212B, S42.213A, S42.213B, S42.214A, S42.214B, S42.215A, S42.215B, S42.216A, S42.216B, S42.221A, S42.221B, S42.222A, S42.222B, S42.223A, S42.223B, S42.224A, S42.224B, S42.225A, S42.225B, S42.226A, S42.226B, S42.231A, S42.231B, S42.232A, S42.232B, S42.239A, S42.239B, S42.241A, S42.241B, S42.242A, S42.242B, S42.249A, S42.249B, S42.251A, S42.251B, S42.252A, S42.252B, S42.253A, S42.253B, S42.254A, S42.254B, S42.255A, S42.255B, S42.256A, S42.256B, S42.261A, S42.261B, S42.262A, S42.262B, S42.263A, S42.263B, S42.264A, S42.264B, S42.265A, S42.265B, S42.266A, S42.266B, S42.271A, S42.272A, S42.279A, S42.291A, S42.291B, S42.292A, S42.292B, S42.293A, S42.293B, S42.294A, S42.294B, S42.295A, S42.295B, S42.296A, S42.296B, S42.301A, S42.301B, S42.302A, S42.302B, S42.309A, S42.309B, S42.321A, S42.321B, S42.322A, S42.322B, S42.323A, S42.323B, S42.324A, S42.324B, S42.325A, S42.325B, S42.326A, S42.326B, S42.331A, S42.331B, S42.332A, S42.332B, S42.333A, S42.333B, S42.334A, S42.334B, S42.335A, S42.335B, S42.336A, S42.336B, S42.341A, S42.341B, S42.342A, S42.342B, S42.343A, S42.343B, S42.344A, S42.344B, S42.345A, S42.345B, S42.346A, S42.346B, S42.351A, S42.351B, S42.352A, S42.352B, S42.353A, S42.353B, S42.354A, S42.354B, S42.355A, S42.355B, S42.356A, S42.356B, S42.361A, S42.361B, S42.362A, S42.362B, S42.363A, S42.363B, S42.364A, S42.364B, S42.365A, S42.365B, S42.366A, S42.366B, S42.391A, S42.391B, S42.392A, S42.392B, S42.399A, S42.399B, S42.401A, S42.401B, S42.402A, S42.402B, S42.409A, S42.409B, S42.411A, S42.411B, S42.412A, S42.412B, S42.413A, S42.413B, S42.414A, S42.414B, S42.415A, S42.415B, S42.416A, S42.416B, S42.421A, S42.421B, S42.422A, S42.422B, S42.423A, S42.423B, S42.424A, S42.424B, S42.425A, S42.425B, S42.426A, S42.426B, S42.431A, S42.431B, S42.432A, S42.432B, S42.433A, 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S72.431C, S72.432A, S72.432B, S72.432C, S72.433A, S72.433B, S72.433C, S72.434A, S72.434B, S72.434C, S72.435A, S72.435B, S72.435C, S72.436A, S72.436B, S72.436C, S72.451A, S72.451B, S72.451C, S72.452A, S72.452B, S72.452C, S72.453A, S72.453B, S72.453C, S72.454A, S72.454B, S72.454C, S72.455A, S72.455B, S72.455C, S72.456A, S72.456B, S72.456C, S72.461A, S72.461B, S72.461C, S72.462A, S72.462B, S72.462C, S72.463A, S72.463B, S72.463C, S72.464A, S72.464B, S72.464C, S72.465A, S72.465B, S72.465C, S72.466A, S72.466B, S72.466C, S72.471A, S72.472A, S72.479A, S72.491A, S72.491B, S72.491C, S72.492A, S72.492B, S72.492C, S72.499A, S72.499B, S72.499C, S72.8X1A, S72.8X1B, S72.8X1C, S72.8X2A, S72.8X2B, S72.8X2C, S72.8X9A, S72.8X9B, S72.8X9C, S72.90XA, S72.90XB, S72.90XC, S72.91XA, S72.91XB, S72.91XC, S72.92XA, S72.92XB, S72.92XC, S82.001A, S82.001B, S82.001C, S82.002A, S82.002B, S82.002C, S82.009A, S82.009B, S82.009C, S82.011A, S82.011B, S82.011C, S82.012A, S82.012B, S82.012C, S82.013A, S82.013B, S82.013C, S82.014A, S82.014B, S82.014C, S82.015A, S82.015B, S82.015C, S82.016A, S82.016B, S82.016C, S82.021A, S82.021B, S82.021C, S82.022A, S82.022B, S82.022C, S82.023A, S82.023B, S82.023C, S82.024A, S82.024B, S82.024C, S82.025A, S82.025B, S82.025C, S82.026A, S82.026B, S82.026C, S82.031A, S82.031B, S82.031C, S82.032A, S82.032B, S82.032C, S82.033A, S82.033B, S82.033C, S82.034A, S82.034B, S82.034C, S82.035A, S82.035B, S82.035C, S82.036A, S82.036B, S82.036C, S82.041A, S82.041B, S82.041C, S82.042A, S82.042B, S82.042C, S82.043A, S82.043B, S82.043C, S82.044A, S82.044B, S82.044C, S82.045A, S82.045B, S82.045C, S82.046A, S82.046B, S82.046C, S82.091A, S82.091B, S82.091C, S82.092A, S82.092B, S82.092C, S82.099A, S82.099B, S82.099C, S82.101A, S82.101B, S82.101C, S82.102A, S82.102B, S82.102C, S82.109A, S82.109B, S82.109C, S82.111A, S82.111B, S82.111C, S82.112A, S82.112B, S82.112C, S82.113A, S82.113B, S82.113C, S82.114A, S82.114B, S82.114C, S82.115A, S82.115B, S82.115C, S82.116A, S82.116B, S82.116C, S82.121A, S82.121B, S82.121C, S82.122A, S82.122B, S82.122C, S82.123A, S82.123B, S82.123C, S82.124A, S82.124B, S82.124C, S82.125A, S82.125B, S82.125C, S82.126A, S82.126B, S82.126C, S82.131A, S82.131B, S82.131C, S82.132A, S82.132B, S82.132C, S82.133A, S82.133B, S82.133C, S82.134A, S82.134B, S82.134C, S82.135A, S82.135B, S82.135C, S82.136A, S82.136B, S82.136C, S82.141A, S82.141B, S82.141C, S82.142A, S82.142B, S82.142C, S82.143A, S82.143B, S82.143C, S82.144A, S82.144B, S82.144C, S82.145A, S82.145B, S82.145C, S82.146A, S82.146B, S82.146C, S82.151A, S82.151B, S82.151C, S82.152A, S82.152B, S82.152C, S82.153A, S82.153B, S82.153C, S82.154A, S82.154B, S82.154C, S82.155A, S82.155B, S82.155C, S82.156A, S82.156B, S82.156C, S82.161A, S82.162A, S82.169A, S82.191A, S82.191B, S82.191C, S82.192A, S82.192B, S82.192C, S82.199A, S82.199B, S82.199C, S82.201A, S82.201B, S82.201C, S82.202A, S82.202B, S82.202C, S82.209A, S82.209B, S82.209C, S82.221A, S82.221B, S82.221C, S82.222A, S82.222B, S82.222C, S82.223A, S82.223B, S82.223C, S82.224A, S82.224B, S82.224C, S82.225A, S82.225B, S82.225C, S82.226A, S82.226B, S82.226C, S82.231A, S82.231B, S82.231C, S82.232A, S82.232B, S82.232C, S82.233A, S82.233B, S82.233C, S82.234A, S82.234B, S82.234C, S82.235A, S82.235B, S82.235C, S82.236A, S82.236B, S82.236C, S82.241A, S82.241B, S82.241C, S82.242A, S82.242B, S82.242C, S82.243A, S82.243B, S82.243C, S82.244A, S82.244B, S82.244C, S82.245A, S82.245B, S82.245C, S82.246A, S82.246B, S82.246C, S82.251A, S82.251B, S82.251C, S82.252A, S82.252B, S82.252C, S82.253A, S82.253B, S82.253C, S82.254A, S82.254B, S82.254C, S82.255A, S82.255B, S82.255C, S82.256A, S82.256B, S82.256C, S82.261A, S82.261B, S82.261C, S82.262A, S82.262B, S82.262C, S82.263A, S82.263B, S82.263C, S82.264A, S82.264B, S82.264C, S82.265A, S82.265B, S82.265C, S82.266A, S82.266B, S82.266C, S82.291A, S82.291B, S82.291C, S82.292A, S82.292B, S82.292C, S82.299A, S82.299B, S82.299C, S82.301A, S82.301B, S82.301C, S82.302A, S82.302B, S82.302C, S82.309A, S82.309B, S82.309C, S82.311A, S82.312A, S82.319A, S82.391A, S82.391B, S82.391C, S82.392A, S82.392B, S82.392C, S82.399A, S82.399B, S82.399C, S82.401A, S82.401B, S82.401C, S82.402A, S82.402B, S82.402C, S82.409A, S82.409B, S82.409C, S82.421A, S82.421B, S82.421C, S82.422A, S82.422B, S82.422C, S82.423A, S82.423B, S82.423C, S82.424A, S82.424B, S82.424C, S82.425A, S82.425B, S82.425C, S82.426A, S82.426B, S82.426C, S82.431A, S82.431B, S82.431C, S82.432A, S82.432B, S82.432C, S82.433A, S82.433B, S82.433C, S82.434A, S82.434B, S82.434C, S82.435A, S82.435B, S82.435C, S82.436A, S82.436B, S82.436C, S82.441A, S82.441B, S82.441C, S82.442A, S82.442B, S82.442C, S82.443A, S82.443B, S82.443C, S82.444A, S82.444B, S82.444C, S82.445A, S82.445B, S82.445C, S82.446A, S82.446B, S82.446C, S82.451A, S82.451B, S82.451C, S82.452A, S82.452B, S82.452C, S82.453A, S82.453B, S82.453C, S82.454A, S82.454B, S82.454C, S82.455A, S82.455B, S82.455C, S82.456A, S82.456B, S82.456C, S82.461A, S82.461B, S82.461C, S82.462A, S82.462B, S82.462C, S82.463A, S82.463B, S82.463C, S82.464A, S82.464B, S82.464C, S82.465A, S82.465B, S82.465C, S82.466A, S82.466B, S82.466C, S82.491A, S82.491B, S82.491C, S82.492A, S82.492B, S82.492C, S82.499A, S82.499B, S82.499C, S82.51XA, S82.51XB, S82.51XC, S82.52XA, S82.52XB, S82.52XC, S82.53XA, S82.53XB, S82.53XC, S82.54XA, S82.54XB, S82.54XC, S82.55XA, S82.55XB, S82.55XC, S82.56XA, S82.56XB, S82.56XC, S82.61XA, S82.61XB, S82.61XC, S82.62XA, S82.62XB, S82.62XC, S82.63XA, S82.63XB, S82.63XC, S82.64XA, S82.64XB, S82.64XC, S82.65XA, S82.65XB, S82.65XC, S82.66XA, S82.66XB, S82.66XC, S82.811A, S82.812A, S82.819A, S82.821A, S82.822A, S82.829A, S82.831A, S82.831B, S82.831C, S82.832A, S82.832B, S82.832C, S82.839A, S82.839B, S82.839C, S82.841A, S82.841B, S82.841C, S82.842A, S82.842B, S82.842C, S82.843A, S82.843B, S82.843C, S82.844A, S82.844B, S82.844C, S82.845A, S82.845B, S82.845C, S82.846A, S82.846B, S82.846C, S82.851A, S82.851B, S82.851C, S82.852A, S82.852B, S82.852C, S82.853A, S82.853B, S82.853C, S82.854A, S82.854B, S82.854C, S82.855A, S82.855B, S82.855C, S82.856A, S82.856B, S82.856C, S82.861A, S82.861B, S82.861C, S82.862A, S82.862B, S82.862C, S82.863A, S82.863B, S82.863C, S82.864A, S82.864B, S82.864C, S82.865A, S82.865B, S82.865C, S82.866A, S82.866B, S82.866C, S82.871A, S82.871B, S82.871C, S82.872A, S82.872B, S82.872C, S82.873A, S82.873B, S82.873C, S82.874A, S82.874B, S82.874C, S82.875A, S82.875B, S82.875C, S82.876A, S82.876B, S82.876C, S82.891A, S82.891B, S82.891C, S82.892A, S82.892B, S82.892C, S82.899A, S82.899B, S82.899C, S82.90XA, S82.90XB, S82.90XC, S82.91XA, S82.91XB, S82.91XC, S82.92XA, S82.92XB, S82.92XC, S92.001A, S92.001B, S92.002A, S92.002B, S92.009A, S92.009B, S92.011A, S92.011B, S92.012A, S92.012B, S92.013A, S92.013B, S92.014A, S92.014B, S92.015A, S92.015B, S92.016A, S92.016B, S92.021A, S92.021B, S92.022A, S92.022B, S92.023A, S92.023B, S92.024A, S92.024B, S92.025A, S92.025B, S92.026A, S92.026B, S92.031A, S92.031B, S92.032A, S92.032B, S92.033A, S92.033B, S92.034A, S92.034B, S92.035A, S92.035B, S92.036A, S92.036B, S92.041A, S92.041B, S92.042A, S92.042B, S92.043A, S92.043B, S92.044A, S92.044B, S92.045A, S92.045B, S92.046A, S92.046B, S92.051A, S92.051B, S92.052A, S92.052B, S92.053A, S92.053B, S92.054A, S92.054B, S92.055A, S92.055B, S92.056A, S92.056B, S92.061A, S92.061B, S92.062A, S92.062B, S92.063A, S92.063B, S92.064A, S92.064B, S92.065A, S92.065B, S92.066A, S92.066B, S92.101A, S92.101B, S92.102A, S92.102B, S92.109A, S92.109B, S92.111A, S92.111B, S92.112A, S92.112B, S92.113A, S92.113B, S92.114A, S92.114B, S92.115A, S92.115B, S92.116A, S92.116B, S92.121A, S92.121B, S92.122A, S92.122B, S92.123A, S92.123B, S92.124A, S92.124B, S92.125A, S92.125B, S92.126A, S92.126B, S92.131A, S92.131B, S92.132A, S92.132B, S92.133A, S92.133B, S92.134A, S92.134B, S92.135A, S92.135B, S92.136A, S92.136B, S92.141A, S92.141B, S92.142A, S92.142B, S92.143A, S92.143B, S92.144A, S92.144B, S92.145A, S92.145B, S92.146A, S92.146B, S92.151A, S92.151B, S92.152A, S92.152B, S92.153A, S92.153B, S92.154A, S92.154B, S92.155A, S92.155B, S92.156A, S92.156B, S92.191A, S92.191B, S92.192A, S92.192B, S92.199A, S92.199B, S92.201A, S92.201B, S92.202A, S92.202B, S92.209A, S92.209B, S92.211A, S92.211B, S92.212A, S92.212B, S92.213A, S92.213B, S92.214A, S92.214B, S92.215A, S92.215B, S92.216A, S92.216B, S92.221A, S92.221B, S92.222A, S92.222B, S92.223A, S92.223B, S92.224A, S92.224B, S92.225A, S92.225B, S92.226A, S92.226B, S92.231A, S92.231B, S92.232A, S92.232B, S92.233A, S92.233B, S92.234A, S92.234B, S92.235A, S92.235B, S92.236A, S92.236B, S92.241A, S92.241B, S92.242A, S92.242B, S92.243A, S92.243B, S92.244A, S92.244B, S92.245A, S92.245B, S92.246A, S92.246B, S92.251A, S92.251B, S92.252A, S92.252B, S92.253A, S92.253B, S92.254A, S92.254B, S92.255A, S92.255B, S92.256A, S92.256B, S92.301A, S92.301B, S92.302A, S92.302B, S92.309A, S92.309B, S92.311A, S92.311B, S92.312A, S92.312B, S92.313A, S92.313B, S92.314A, S92.314B, S92.315A, S92.315B, S92.316A, S92.316B, S92.321A, S92.321B, S92.322A, S92.322B, S92.323A, S92.323B, S92.324A, S92.324B, S92.325A, S92.325B, S92.326A, S92.326B, S92.331A, S92.331B, S92.332A, S92.332B, S92.333A, S92.333B, S92.334A, S92.334B, S92.335A, S92.335B, S92.336A, S92.336B, S92.341A, S92.341B, S92.342A, S92.342B, S92.343A, S92.343B, S92.344A, S92.344B, S92.345A, S92.345B, S92.346A, S92.346B, S92.351A, S92.351B, S92.352A, S92.352B, S92.353A, S92.353B, S92.354A, S92.354B, S92.355A, S92.355B, S92.356A, S92.356B, S92.811A, S92.811B, S92.812A, S92.812B, S92.819A, S92.819B, S92.901A, S92.901B, S92.902A, S92.902B, S92.909A,S92.909B

AND

Patient encounter during the performance period (CPT or HCPCS): 98966, 98967, 98968, 98970, 98971, 98972, 98980, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99238, 99239, 99242*, 99243*, 99244*, 99245*, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99386*, 99387*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99421, 99422, 99423, 99429*, 99441, 99442, 99443, 99455, 99456, 99457, 99483, G0071, G0402, G0438, G0439, G0463*, G2010, G2012, T1015

WITHOUT

Place of Service (POS): 21

AND NOT

DENOMINATOR EXCLUSIONS:

Patients who utilize hospice services any time during the measurement period: G9768

Patient had a bone mineral density test in the past two years OR received osteoporosis medication or therapy in the past 12 months: G9769

Patients who receive palliative care services any time during the intake period through the end of the measurement year: G0048

Patients age 66 or older in Institutional Special Needs Plans (SNP) or residing in long-term care with POS code, 32, 33, 34, 54, or 56 for more than 90 consecutive days during the six months prior to the measurementperiod through December 31 of the measurement period: G9938

Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period AND a dispensed medication for dementia during the measurement period or the year prior to the measurement period: G2127

Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period AND either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ED or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period: G2126

Patients 81 years of age and older with at least one claim/encounter for frailty during the six months prior to the measurementperiod through December 31 of the measurement period: G2125

Table: Dementia Exclusion Medications

Description	Prescriptions
Cholinesterase inhibitors	Donepezil Galantamine	Rivastigimine
Miscellaneous central nervous system agents	Memantine
Dementia combinations	Donepezilmemantine

Codes to identify Frailty: 99504, 99509, E0100, E0105, E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149, E0163, E0165, E0167, E0168, E0170, E0171, E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0270, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0301, E0302, E0303, E0304, E0424, E0425, E0430, E0431, E0433, E0434, E0435, E0439, E0440, E0441, E0442, E0443, E0444, E0462, E0465, E0466, E0470, E0471, E0472, E0561, E0562, E1130, E1140, E1150, E1160, E1161, E1240, E1250, E1260, E1270, E1280, E1285, E1290, E1295, E1296, E1297, E1298, G0162, G0299, G0300, G0493, G0494, S0271, S0311, S9123, S9124, T1000, T1001, T1002, T1003, T1004, T1005, T1019, T1020, T1021, T1022, T1030, T1031, L89.000, L89.001, L89.002, L89.003, L89.004, L89.006, L89.009, L89.010, L89.011, L89.012, L89.013, L89.014, L89.016, L89.019, L89.020, L89.021, L89.022, L89.023, L89.024, L89.026, L89.029, L89.100, L89.101, L89.102, L89.103, L89.104, L89.106, L89.109, L89.110, L89.111, L89.112, L89.113, L89.114, L89.116, L89.119, L89.120, L89.121, L89.122, L89.123, L89.124, L89.126, L89.129, L89.130, L89.131, L89.132, L89.133, L89.134, L89.136, L89.139, L89.140, L89.141, L89.142, L89.143, L89.144, L89.146, L89.149, L89.150, L89.151, L89.152, L89.153, L89.154, L89.156, L89.159, L89.200, L89.201, L89.202, L89.203, L89.204, L89.206, L89.209, L89.210, L89.211, L89.212, L89.213, L89.214, L89.216, L89.219, L89.220, L89.221, L89.222, L89.223, L89.224, L89.226, L89.229, L89.300, L89.301, L89.302, L89.303, L89.304, L89.306, L89.309, L89.310, L89.311, L89.312, L89.313, L89.314, L89.316, L89.319, L89.320, L89.321, L89.322, L89.323, L89.324, L89.326, L89.329, L89.40, L89.41, L89.42, L89.43, L89.44, L89.45, L89.46, L89.500, L89.501, L89.502, L89.503, L89.504, L89.506, L89.509, L89.510, L89.511, L89.512, L89.513, L89.514, L89.516, L89.519, L89.520, L89.521, L89.522, L89.523, L89.524, L89.526, L89.529, L89.600, L89.601, L89.602, L89.603, L89.604, L89.606, L89.609, L89.610, L89.611, L89.612, L89.613, L89.614, L89.616, L89.619, L89.620, L89.621, L89.622, L89.623, L89.624, L89.626, L89.629, L89.810, L89.811, L89.812, L89.813, L89.814, L89.816, L89.819, L89.890, L89.891, L89.892, L89.893, L89.894, L89.896, L89.899, L89.90, L89.91, L89.92, L89.93, L89.94, L89.95, L89.96, M62.50, M62.81, M62.84, R26.2, R26.89, R26.9, R53.1, R53.81, R54, R62.7, R63.4, R63.6, R64, W01.0XXA, W01.0XXD, W01.0XXS, W01.10XA, W01.10XD, W01.10XS, W01.110A, W01.110D, W01.110S, W01.111A, W01.111D, W01.111S, W01.118A, W01.118D, W01.118S, W01.119A, W01.119D, W01.119S, W01.190A, W01.190D, W01.190S, W01.198A, W01.198D, W01.198S, W06.XXXA, W06.XXXD, W06.XXXS, W07.XXXA, W07.XXXD, W07.XXXS, W08.XXXA, W08.XXXD, W08.XXXS, W10.0XXA, W10.0XXD, W10.0XXS, W10.1XXA, W10.1XXD, W10.1XXS, W10.2XXA, W10.2XXD, W10.2XXS, W10.8XXA, W10.8XXD, W10.8XXS, W10.9XXA, W10.9XXD, W10.9XXS, W18.00XA, W18.00XD, W18.00XS, W18.02XA, W18.02XD, W18.02XS, W18.09XA, W18.09XD, W18.09XS, W18.11XA, W18.11XD, W18.11XS, W18.12XA, W18.12XD, W18.12XS, W18.2XXA, W18.2XXD, W18.2XXS, W18.30XA, W18.30XD, W18.30XS, W18.31XA, W18.31XD, W18.31XS, W18.39XA, W18.39XD, W18.39XS, W19.XXXA, W19.XXXD, W19.XXXS, Y92.199, Z59.3, Z73.6, Z74.01, Z74.09, Z74.1, Z74.2, Z74.3, Z74.8, Z74.9, Z91.81, Z99.11, Z99.3, Z99.81, Z99.89

Codes to identify Advanced Illness: A81.00, A81.01, A81.09, C25.0, C25.1, C25.2, C25.3, C25.4, C25.7, C25.8, C25.9, C71.0, C71.1, C71.2, C71.3, C71.4, C71.5, C71.6, C71.7, C71.8, C71.9, C77.0, C77.1, C77.2, C77.3, C77.4, C77.5, C77.8, C77.9, C78.00, C78.01, C78.02, C78.1, C78.2, C78.30, C78.39, C78.4, C78.5, C78.6, C78.7, C78.80, C78.89, C79.00, C79.01, C79.02, C79.10, C79.11, C79.19, C79.2, C79.31, C79.32, C79.40, C79.49, C79.51, C79.52, C79.60, C79.61, C79.62, C79.70, C79.71, C79.72, C79.81, C79.82, C79.89, C79.9, C91.00, C91.02, C92.00, C92.02, C93.00, C93.02, C93.90, C93.92, C93.Z0, C93.Z2, C94.30, C94.32, F01.50, F01.511, F01.518, F01.52, F01.53, F01.54, F01.A0, F01.A11, F01.A18, F01.A2, F01.A3, F01.A4, F01.B0, F01.B11, F01.B18, F01.B2, F01.B3, F01.B4, F01.C0, F01.C11, F01.C18, F01.C2, F01.C3, F01.C4, F02.80, F02.811, F02.818, F02.82, F02.83, F02.84, F02.A0, F02.A11, F02.A18, F02.A2, F02.A3, F02.A4, F02.B0, F02.B11, F02.B18, F02.B2, F02.B3, F02.B4, F02.C0, F02.C11, F02.C18, F02.C2, F02.C3, F02.C4, F03.90, F03.911, F03.918, F03.92, F03.93, F03.94, F03.A0, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B0, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C0, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, F04, F10.27, F10.96, F10.97, G10, G12.21, G20, G20.A1, G20.A2, G20.B1, G20.B2, G20.C, G30.0, G30.1, G30.8, G30.9, G31.01, G31.09, G31.83, I09.81, I11.0, I12.0, I13.0, I13.11, I13.2, I50.1, I50.20, I50.21, I50.22, I50.23, I50.30, I50.31, I50.32, I50.33, I50.40, I50.41, I50.42, I50.43, I50.810, I50.811, I50.812, I50.813, I50.814, I50.82, I50.83, I50.84, I50.89, I50.9, J43.0, J43.1, J43.2, J43.8, J43.9, J68.4, J84.10, J84.112, J84.170, J84.178, J96.10, J96.11, J96.12, J96.20, J96.21, J96.22, J96.90, J96.91, J96.92, J98.2, J98.3, K70.10, K70.11, K70.2, K70.30, K70.31, K70.40, K70.41, K70.9, K74.00, K74.01, K74.02, K74.1, K74.2, K74.4, K74.5, K74.60, K74.69, N18.5, N18.6

Option 2 - Denominator Criteria (Eligible Cases):

Patients aged 50-85 years on date of encounter

AND

Diagnosis for any fracture except fractures of the finger, toe, face or skull (ICD-10-CM): M48.40XA, M48.41XA, M48.42XA, M48.43XA, M48.44XA, M48.45XA, M48.46XA, M48.47XA, M48.48XA, M80.00XA, M80.011A, M80.012A, M80.019A, M80.021A, M80.022A, M80.029A, M80.031A, M80.032A, M80.039A, M80.041A, M80.042A, M80.049A, M80.051A, M80.052A, M80.059A, M80.061A, M80.062A, M80.069A, M80.071A, M80.072A, M80.079A, M80.08XA, M80.80XA, M80.811A, M80.812A, M80.819A, M80.821A, M80.822A, M80.829A, M80.831A, M80.832A, M80.839A, M80.841A, M80.842A, M80.849A, M80.851A, M80.852A, M80.859A, M80.861A, M80.862A, M80.869A, M80.871A, M80.872A, M80.879A, M80.88XA, M80.0AXA, M80.0B1A, M80.0B1D, M80.0B1G, M80.0B1K, M80.0B1P, M80.0B1S, M80.0B2A, M80.0B2D, M80.0B2G, M80.0B2K, M80.0B2P, M80.0B2S, M80.0B9A, M80.0B9D, M80.0B9G, M80.0B9K, M80.0B9P, M80.0B9S, M80.8AXA, M80.8B1A, M80.8B1D, M80.8B1G, M80.8B1K, M80.8B1P, M80.8B1S, M80.8B2A, M80.8B2D, M80.8B2G, M80.8B2K, M80.8B2P, M80.8B2S, M80.8B9A, M80.8B9D, M80.8B9G, M80.8B9K, M80.8B9P, M80.8B9S, M84.311A, M84.312A, M84.319A, M84.321A, M84.322A, M84.329A, M84.331A, M84.332A, M84.333A, M84.334A, M84.339A, M84.341A, M84.342A, M84.343A, M84.350A, M84.351A, M84.352A, M84.353A, M84.359A, M84.361A, M84.362A, M84.363A, M84.364A, M84.369A, M84.371A, M84.372A, M84.373A, M84.374A, M84.375A, M84.376A, M84.38XA, M84.750A, M84.751A, M84.752A, M84.753A, M84.754A, M84.755A, M84.756A, M84.757A, M84.759A, M97.01XA, M97.02XA, M97.11XA, M97.12XA, M97.21XA, M97.22XA, M97.31XA, M97.32XA, M97.41XA, M97.42XA, S12.000A, S12.000B, S12.001A, S12.001B, S12.01XA, S12.01XB, S12.02XA, S12.02XB, S12.030A, S12.030B, S12.031A, S12.031B, S12.040A, S12.040B, S12.041A, S12.041B, S12.090A, S12.090B, S12.091A, S12.091B, S12.100A, S12.100B, S12.101A, S12.101B, S12.110A, S12.110B, S12.111A, S12.111B, S12.112A, S12.112B, S12.120A, S12.120B, S12.121A, S12.121B, S12.130A, S12.130B, S12.131A, S12.131B, S12.14XA, S12.14XB, S12.150A, S12.150B, S12.151A, S12.151B, S12.190A, S12.190B, S12.191A, S12.191B, S12.200A, S12.200B, S12.201A, S12.201B, S12.230A, S12.230B, S12.231A, S12.231B, S12.24XA, S12.24XB, S12.250A, S12.250B, S12.251A, S12.251B, S12.290A, S12.290B, S12.291A, S12.291B, S12.300A, S12.300B, S12.301A, S12.301B, S12.330A, S12.330B, S12.331A, S12.331B, S12.34XA, S12.34XB, S12.350A, S12.350B, S12.351A, S12.351B, S12.390A, S12.390B, S12.391A, S12.391B, S12.400A, S12.400B, S12.401A, S12.401B, S12.430A, S12.430B, S12.431A, S12.431B, S12.44XA, S12.44XB, S12.450A, S12.450B, S12.451A, S12.451B, S12.490A, S12.490B, S12.491A, S12.491B, S12.500A, S12.500B, S12.501A, S12.501B, S12.530A, S12.530B, S12.531A, S12.531B, S12.54XA, S12.54XB, S12.550A, S12.550B, S12.551A, S12.551B, S12.590A, S12.590B, S12.591A, S12.591B, S12.600A, S12.600B, S12.601A, S12.601B, S12.630A, S12.630B, S12.631A, S12.631B, S12.64XA, S12.64XB, S12.650A, S12.650B, S12.651A, S12.651B, S12.690A, S12.690B, S12.691A, S12.691B, S12.8XXA, S12.9XXA, S22.000A, S22.000B, S22.001A, S22.001B, S22.002A, S22.002B, S22.008A, S22.008B, S22.009A, S22.009B, S22.010A, S22.010B, S22.011A, S22.011B, S22.012A, S22.012B, S22.018A, S22.018B, S22.019A, S22.019B, S22.020A, S22.020B, S22.021A, S22.021B, S22.022A, S22.022B, S22.028A, S22.028B, S22.029A, S22.029B, S22.030A, S22.030B, S22.031A, S22.031B, S22.032A, S22.032B, S22.038A, S22.038B, S22.039A, S22.039B, S22.040A, S22.040B, S22.041A, S22.041B, S22.042A, S22.042B, S22.048A, S22.048B, S22.049A, S22.049B, S22.050A, S22.050B, S22.051A, S22.051B, S22.052A, S22.052B, S22.058A, S22.058B, S22.059A, S22.059B, S22.060A, S22.060B, S22.061A, S22.061B, S22.062A, S22.062B, S22.068A, S22.068B, S22.069A, S22.069B, S22.070A, S22.070B, S22.071A, S22.071B, S22.072A, S22.072B, S22.078A, S22.078B, S22.079A, S22.079B, S22.080A, S22.080B, S22.081A, S22.081B, S22.082A, S22.082B, S22.088A, S22.088B, S22.089A, S22.089B, S22.20XA, S22.20XB, S22.21XA, S22.21XB, S22.22XA, S22.22XB, S22.23XA, S22.23XB, S22.24XA, S22.24XB, S22.31XA, S22.31XB, S22.32XA, S22.32XB, S22.39XA, S22.39XB, S22.41XA, S22.41XB, S22.42XA, S22.42XB, S22.43XA, S22.43XB, S22.49XA, S22.49XB, S22.5XXA, S22.5XXB, S22.9XXA, S22.9XXB, S32.000A, S32.000B, S32.001A, S32.001B, S32.002A, S32.002B, S32.008A, S32.008B, S32.009A, S32.009B, S32.010A, S32.010B, S32.011A, S32.011B, S32.012A, S32.012B, S32.018A, S32.018B, S32.019A, S32.019B, S32.020A, S32.020B, S32.021A, S32.021B, S32.022A, S32.022B, S32.028A, S32.028B, S32.029A, S32.029B, S32.030A, S32.030B, S32.031A, S32.031B, S32.032A, S32.032B, S32.038A, S32.038B, S32.039A, S32.039B, S32.040A, S32.040B, S32.041A, S32.041B, S32.042A, S32.042B, S32.048A, S32.048B, S32.049A, S32.049B, S32.050A, S32.050B, S32.051A, S32.051B, S32.052A, S32.052B, S32.058A, S32.058B, S32.059A, S32.059B, S32.10XA, S32.10XB, S32.110A, S32.110B, S32.111A, S32.111B, S32.112A, S32.112B, S32.119A, S32.119B, S32.120A, S32.120B, S32.121A, S32.121B, S32.122A, S32.122B, S32.129A, S32.129B, S32.130A, S32.130B, S32.131A, S32.131B, S32.132A, S32.132B, S32.139A, S32.139B, S32.14XA, S32.14XB, S32.15XA, S32.15XB, S32.16XA, S32.16XB, S32.17XA, S32.17XB, S32.19XA, S32.19XB, S32.2XXA, S32.2XXB, S32.301A, S32.301B, S32.302A, S32.302B, S32.309A, S32.309B, S32.311A, S32.311B, S32.312A, S32.312B, S32.313A, S32.313B, S32.314A, S32.314B, S32.315A, S32.315B, S32.316A, S32.316B, S32.391A, S32.391B, S32.392A, S32.392B, S32.399A, S32.399B, S32.401A, S32.401B, S32.402A, S32.402B, S32.409A, S32.409B, S32.411A, S32.411B, S32.412A, S32.412B, S32.413A, S32.413B, S32.414A, S32.414B, S32.415A, S32.415B, S32.416A, S32.416B, S32.421A, S32.421B, S32.422A, S32.422B, S32.423A, S32.423B, S32.424A, S32.424B, S32.425A, S32.425B, S32.426A, S32.426B, S32.431A, S32.431B, S32.432A, S32.432B, S32.433A, S32.433B, S32.434A, S32.434B, S32.435A, S32.435B, S32.436A, S32.436B, S32.441A, S32.441B, S32.442A, S32.442B, S32.443A, S32.443B, S32.444A, S32.444B, S32.445A, S32.445B, S32.446A, S32.446B, S32.451A, S32.451B, S32.452A, S32.452B, S32.453A, S32.453B, S32.454A, S32.454B, S32.455A, S32.455B, S32.456A, S32.456B, S32.461A, S32.461B, S32.462A, S32.462B, S32.463A, S32.463B, S32.464A, S32.464B, S32.465A, S32.465B, S32.466A, S32.466B, S32.471A, S32.471B, S32.472A, S32.472B, S32.473A, S32.473B, S32.474A, S32.474B, S32.475A, S32.475B, S32.476A, S32.476B, S32.481A, S32.481B, S32.482A, S32.482B, S32.483A, S32.483B, S32.484A, S32.484B, S32.485A, S32.485B, S32.486A, S32.486B, S32.491A, S32.491B, S32.492A, S32.492B, S32.499A, S32.499B, S32.501A, S32.501B, S32.502A, S32.502B, S32.509A, S32.509B, S32.511A, S32.511B, S32.512A, S32.512B, S32.519A, S32.519B, S32.591A, S32.591B, S32.592A, S32.592B, S32.599A, S32.599B, S32.601A, S32.601B, S32.602A, S32.602B, S32.609A, S32.609B, S32.611A, S32.611B, S32.612A, S32.612B, S32.613A, S32.613B, S32.614A, S32.614B, S32.615A, S32.615B, S32.616A, S32.616B, S32.691A, S32.691B, S32.692A, S32.692B, S32.699A, S32.699B, S32.810A, S32.810B, S32.811A, S32.811B, S32.82XA, S32.82XB, S32.89XA, S32.89XB, S32.9XXA, S32.9XXB, S42.001A, S42.001B, S42.002A, S42.002B, S42.009A, S42.009B, S42.011A, S42.011B, S42.012A, S42.012B, S42.013A, S42.013B, S42.014A, S42.014B, S42.015A, S42.015B, S42.016A, S42.016B, S42.017A, S42.017B, S42.018A, S42.018B, S42.019A, S42.019B, S42.021A, S42.021B, S42.022A, S42.022B, S42.023A, S42.023B, S42.024A, S42.024B, S42.025A, S42.025B, S42.026A, S42.026B, S42.031A, S42.031B, S42.032A, S42.032B, S42.033A, S42.033B, S42.034A, S42.034B, S42.035A, S42.035B, S42.036A, S42.036B, S42.101A, S42.101B, S42.102A, S42.102B, S42.109A, S42.109B, S42.111A, S42.111B, S42.112A, S42.112B, S42.113A, S42.113B, S42.114A, S42.114B, S42.115A, S42.115B, S42.116A, S42.116B, S42.121A, S42.121B, S42.122A, S42.122B, S42.123A, S42.123B, S42.124A, S42.124B, S42.125A, S42.125B, S42.126A, S42.126B, S42.131A, S42.131B, S42.132A, S42.132B, S42.133A, S42.133B, S42.134A, S42.134B, S42.135A, S42.135B, S42.136A, S42.136B, S42.141A, S42.141B, S42.142A, S42.142B, S42.143A, S42.143B, S42.144A, S42.144B, S42.145A, S42.145B, S42.146A, S42.146B, S42.151A, S42.151B, S42.152A, S42.152B, S42.153A, S42.153B, 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S92.035B, S92.036A, S92.036B, S92.041A, S92.041B, S92.042A, S92.042B, S92.043A, S92.043B, S92.044A, S92.044B, S92.045A, S92.045B, S92.046A, S92.046B, S92.051A, S92.051B, S92.052A, S92.052B, S92.053A, S92.053B, S92.054A, S92.054B, S92.055A, S92.055B, S92.056A, S92.056B, S92.061A, S92.061B, S92.062A, S92.062B, S92.063A, S92.063B, S92.064A, S92.064B, S92.065A, S92.065B, S92.066A, S92.066B, S92.101A, S92.101B, S92.102A, S92.102B, S92.109A, S92.109B, S92.111A, S92.111B, S92.112A, S92.112B, S92.113A, S92.113B, S92.114A, S92.114B, S92.115A, S92.115B, S92.116A, S92.116B, S92.121A, S92.121B, S92.122A, S92.122B, S92.123A, S92.123B, S92.124A, S92.124B, S92.125A, S92.125B, S92.126A, S92.126B, S92.131A, S92.131B, S92.132A, S92.132B, S92.133A, S92.133B, S92.134A, S92.134B, S92.135A, S92.135B, S92.136A, S92.136B, S92.141A, S92.141B, S92.142A, S92.142B, S92.143A, S92.143B, S92.144A, S92.144B, S92.145A, S92.145B, S92.146A, S92.146B, S92.151A, S92.151B, S92.152A, S92.152B, S92.153A, S92.153B, S92.154A, S92.154B, S92.155A, S92.155B, S92.156A, S92.156B, S92.191A, S92.191B, S92.192A, S92.192B, S92.199A, S92.199B, S92.201A, S92.201B, S92.202A, S92.202B, S92.209A, S92.209B, S92.211A, S92.211B, S92.212A, S92.212B, S92.213A, S92.213B, S92.214A, S92.214B, S92.215A, S92.215B, S92.216A, S92.216B, S92.221A, S92.221B, S92.222A, S92.222B, S92.223A, S92.223B, S92.224A, S92.224B, S92.225A, S92.225B, S92.226A, S92.226B, S92.231A, S92.231B, S92.232A, S92.232B, S92.233A, S92.233B, S92.234A, S92.234B, S92.235A, S92.235B, S92.236A, S92.236B, S92.241A, S92.241B, S92.242A, S92.242B, S92.243A, S92.243B, S92.244A, S92.244B, S92.245A, S92.245B, S92.246A, S92.246B, S92.251A, S92.251B, S92.252A, S92.252B, S92.253A, S92.253B, S92.254A, S92.254B, S92.255A, S92.255B, S92.256A, S92.256B, S92.301A, S92.301B, S92.302A, S92.302B, S92.309A, S92.309B, S92.311A, S92.311B, S92.312A, S92.312B, S92.313A, S92.313B, S92.314A, S92.314B, S92.315A, S92.315B, S92.316A, S92.316B, S92.321A, S92.321B, S92.322A, S92.322B, S92.323A, S92.323B, S92.324A, S92.324B, S92.325A, S92.325B, S92.326A, S92.326B, S92.331A, S92.331B, S92.332A, S92.332B, S92.333A, S92.333B, S92.334A, S92.334B, S92.335A, S92.335B, S92.336A, S92.336B, S92.341A, S92.341B, S92.342A, S92.342B, S92.343A, S92.343B, S92.344A, S92.344B, S92.345A, S92.345B, S92.346A, S92.346B, S92.351A, S92.351B, S92.352A, S92.352B, S92.353A, S92.353B, S92.354A, S92.354B, S92.355A, S92.355B, S92.356A, S92.356B, S92.811A, S92.811B, S92.812A, S92.812B, S92.819A, S92.819B, S92.901A, S92.901B, S92.902A, S92.902B, S92.909A, S92.909B

AND

Patient procedure during the performance period (CPT): 22310, 22315, 22318, 22319, 22325, 22326, 22327, 22510, 22511, 22513, 22514, 25600, 25605, 25606, 25607, 25608, 25609, 27230, 27232, 27235, 27236, 27238, 27240, 27244, 27245, 27246, 27248

AND NOT

DENOMINATOR EXCLUSIONS:

Patients who utilize hospice services any time during the measurement period: G9768

Patients who receive palliative care services any time during the intake period through the end of the measurement year: G0048

Patient had a bone mineral density test in the past two years OR received osteoporosis medication or therapy in the past 12 months: G9769

Patients aged 66 or older in Institutional Special Needs Plans (SNP) or residing in long-term care with POS code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the six months prior to the measurement period through December 31 of the measurement period: G9938

Patients 81 years of age and older with at least one claim/encounter for frailty during the six months prior to the measurement period through December 31 of the measurement period: G2125

Table: Dementia Exclusion Medications

Description	Prescriptions
Cholinesterase inhibitors	Donepezil Galantamine	Rivastigimine
Miscellaneous central nervous system agents	Memantine
Dementia combinations	Donepezilmemantine

Numerator

Patients who received either a bone mineral density test or a prescription for a drug to treat osteoporosis in the six months after the fracture

Definitions:

Pharmacologic Therapy – U.S. Food and Drug Administration approved pharmacologic options for osteoporosis prevention and/or treatment of postmenopausal osteoporosis include: bisphosphonates, alendronate, alendronate-cholecalciferol, ibandronate, risedronate, zoledronic acid, teriparatide, denosumab, abaloparatide, romosozumab and raloxifine.

Prescribed – May include prescription given to the patient for treatment of osteoporosis (as listed above) at one or more encounters during the performance period, or documentation that patient is already taking pharmacologic therapy for osteoporosis, as documented in the current medical list.

Bone Mineral Density (BMD) – A bone density test is an examination by either special x-rays or ultrasound to determine how much bone mineral content (calcium and other minerals) is present in any section of bone.

NUMERATOR NOTE: While the Central Dual Energy X-Ray Absorptiometry (DXA) is the most common measurement for measuring bone mineral density (BMD), for the purposes of submitting this measure, spinal densitometry X-ray, ultrasonography for densitometry, CT bone density axial and Peripheral Dual-energy XRay Absorptiometry (DXA) would meet performance and the intent of the measure and 3095F would be submitted.

Numerator Options:

Performance Met: Central Dual-energy X-Ray Absorptiometry (DXA) results documented (3095F)

Performance Met: Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed (G8633)

Performance Not Met: Central Dual energy X-ray absorptiometry (DXA) measurement was not performed, reason not otherwise specified (3095F with 8P)

Performance Not Met: Pharmacologic therapy for osteoporosis was not prescribed, reason not given (G8635)

Rationale

The intent of this measure is secondary prevention of fractures through the appropriate diagnosis and treatment of osteoporosis. Detecting osteoporosis and initiating treatment will help to prevent future fractures from occurring.

Future fractures, especially in the older population, can cause significant health issues, decline in function, and, in some cases lead to mortality.

Clinical Recommendation Statements

The U.S. Preventive Services Task Force (USPSTF) recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older (Grade B) (USPSTF 2018).

This recommendation applies to older adults without a history of low-trauma fractures and without conditions that may cause secondary osteoporosis (such as metabolic bone disease or untreated hyperthyroidism) and patients without conditions that may increase their risk of falls. This recommendation does not apply to persons who take long-term medications that may cause secondary osteoporosis (e.g., glucocorticoids, aromatase inhibitors, or gonadotropin-releasing hormone agonists). The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool (Grade B) (USPSTF 2018).

U.S. Preventive Services Task Force (USPSTF). Final Recommendation Statement - Osteoporosis to Prevent Fractures: Screening. June 2018. Accessed at: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosisscreening#fullrecommendationstart.

2024 MIPS Measure #418: Osteoporosis Management in Women Who Had a Fracture

Measure Description

Instructions

Measure Submission Type:

Denominator

Option 1 - Denominator Criteria (Eligible Cases):

Option 2 - Denominator Criteria (Eligible Cases):

Numerator

Definitions:

Numerator Options:

Rationale

Clinical Recommendation Statements

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