Measure Description
Percentage of patients 13 years of age and older with a diagnosis of HIV who had tests for syphilis, gonorrhea, and chlamydia performed within the performance period.
Instructions
This measure is to be submitted a minimum of once per performance period for patients with HIV seen during the performance period. This measure is intended to reflect the quality of services provided for the primary management of patients with HIV. 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.
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. Please note that effective January 1, 2025, while a measure may be denoted as telehealth eligible, specific denominator codes within the encounter may no longer be eligible due to changes outlined in the CY 2024 PFS Final Rule List of Medicare Telehealth Services.
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 13 years of age and older at the start of the performance period with a diagnosis of HIV before the end of the performance period with an eligible encounter during the performance period
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 ≥ 13 years at the start of the performance period
AND
Diagnosis for HIV before the end of the performance period (ICD-10-CM): B20, B97.35, Z21, O98.711, O98.712, O98.713, O98.719, O98.72, O98.73
AND
Patient encounters during the performance period (CPT or HCPCS): 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 98966, 98967, 98968, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242*, 99244*, 99245*, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99381*, 99382*, 99383*, 99384*, 99385*, 99386*, 99387*, 99391*, 99392*, 99393*, 99394*, 99395*, 99396*, 99397*, 99429*, G0402, G0438, G0439
Numerator
Patients who were tested for each of the following at least once during the performance period: syphilis, gonorrhea, and chlamydia
NUMERATOR NOTE: Submit G9228 when results are documented for all of the 3 screenings
Numerator Options:
Performance Met: Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings) (G9228)
OR
Performance Not Met: Chlamydia, gonorrhea, and syphilis not screened, reason not given (G9230)
Rationale
In 2024, the combined total number of cases of chlamydia, gonorrhea, and syphilis declined 9% from 2023, down a third consecutive year. There were still more than 2.2 million reported STIs in 2024, and compared to a decade ago, overall cases are 13% higher; congenital syphilis is nearly 700% higher (CDC, 2025). CDC data from 2023 indicates that 46% of people with HIV were tested for chlamydia, gonorrhea, and syphilis in the 12-month period (CDC, 2024). In 2022, men who have sex with men accounted for 45% of all make primary and secondar syphilis and approximately 36% of men who have sex with men with primary and secondary syphilis also had HIV (CDC, 2023). Chlamydia and gonorrhea infections among women can result in pelvic inflammatory disease, ectopic pregnancy, and infertility. This measure will help providers focus their attention and quality improvement efforts towards testing and treating sexually transmitted infections in patients with HIV, thus reducing the complications to long-term syphilis infection and reducing STI incidence (Patel et al., 2012).
Clinical Recommendation Statements
"At the initial HIV care visit, providers should screen all sexually active persons for syphilis, gonorrhea, and chlamydia, and perform screening for these infections at least annually during the course of HIV care. Specific testing includes syphilis serology and nucleic acid amplification test (NAAT) for N. gonorrhoeae and C. trachomatis at the anatomic site of exposure…. More frequent screening for syphilis, gonorrhea, and chlamydia (e.g., every 3 or 6 months) should be tailored to individual risk behavior and the local prevalence of specific STIs.
“Rectal and pharyngeal testing by NAAT for gonorrhea and chlamydia is recognized as an important sexual health consideration for [men who have sex with men] MSM…. Pharyngeal infections with gonorrhea or chlamydia might be a principal source of urethral infections…. Approximately 70% of gonococcal and chlamydial infections might be missed if urogenital-only testing is performed among [men who have sex with men] MSM because most pharyngeal and rectal infections are asymptomatic. Self-collected swabs have been reported to be an acceptable means of collection for pharyngeal and rectal specimens, which can enhance patient comfort and reduce clinical workloads.
“For women, C. trachomatis urogenital infection can be diagnosed by vaginal or cervical swabs or first-void urine. For men, C. trachomatis urethral infection can be diagnosed by testing first-void urine or a urethral swab. NAATs are the most sensitive tests for these specimens and are the recommended test for detecting C. trachomatis infection. NAATs that are FDA cleared for use with vaginal swab specimens can be collected by a clinician or patient in a clinical setting. Patient collected vaginal swab specimens are equivalent in sensitivity and specificity to those collected by a clinician using NAATs, and this screening strategy is highly acceptable among women.
“Recent studies have demonstrated that among men, NAAT performance on self-collected meatal swabs is comparable to patient-collected urine or provider-collected urethral swabs. Patient collection of a meatal swab for C. trachomatis testing might be a reasonable approach for men who are either unable to provide urine or prefer to collect their own meatal swab over providing urine. “Rectal and oropharyngeal C. trachomatis infection among persons engaging in receptive anal or oral intercourse can be diagnosed by testing at the anatomic exposure site…. Data indicate that NAAT performance on self-collected rectal swabs is comparable to clinician-collected rectal swabs, and this specimen collection strategy for rectal C. trachomatis screening is highly acceptable among men. Self-collected rectal swabs are a reasonable alternative to clinician-collected rectal swabs for C. trachomatis screening by NAAT, especially when clinicians are not available or when self-collection is preferred over clinician collection. Annual screening for rectal C. trachomatis infection should be performed among men who report sexual activity at the rectal site. Extragenital chlamydial testing at the rectal site can be considered for females on the basis of reported sexual behaviors and exposure through shared clinical decision-making by the patient and the provider. The majority of persons with C. trachomatis detected at oropharyngeal sites do not have oropharyngeal symptoms.”(Workowski, 2021)
References:
Centers for Disease Control and Prevention. Sexually Transmitted Infections Surveillance 2024 (Provisional). Atlanta: U.S. Department of Health and Human Services; 2025.
Centers for Disease Control and Prevention. Behavioral and Clinical Characteristics of Persons with Diagnosed HIV Infection—Medical Monitoring Project, United States, 2022 Cycle (June 2022–May 2023). HIV Surveillance Special Report 36. https://stacks.cdc.gov/view/cdc/159149. Published July 2024. Accessed November 2025.
Centers for Disease Control and Prevention. Sexually Transmitted Infections Surveillance 2023. Atlanta: U.S. Department of Health and Human Services; 2025.
Patel, et all. Routine Brief Risk-Reduction Counseling With Biannual STD Testing Reduces STD Incidence Among HIVInfected Men Who Have Sex With Men in Care. Sex Transm Dis. 2012 June; 39(6): 470– 474.doi:10.1097/OLQ.0b013e31824b3110
Workowski, KA, Bachmann, LH, Chan, PA, Johnston CM, Muzny, CA, Park, I, Reno, H, Zenilman, JA, & Bolan, GA. "Sexually Transmitted Infections Treatment Guidelines, 2021" (PDF). MMWR Recomm Rep 2021; 70(No. RR-4): 16, 26, 66. Available online. Accessed October 2025.