eMeasure ID: 1.1
eMeasure NQF: N/A
NQF: 3059
Quality ID: 400
NQS DOMAIN - Effective Clinical Care
MEASURE TYPE - Process

DESCRIPTION: Percentage of patients aged 18 years and older with one or more of the following: a history of injection drug use, receipt of a blood transfusion prior to 1992, receiving maintenance hemodialysis, OR birthdate in the years 1945-1965 who received one-time screening for hepatitis C virus (HCV) infection


DENOMINATOR:All patients aged 18 years and older who were seen twice for any visit or who had at least one preventive visit withinthe 12 month reporting period with one or more of the following: a history of injection drug use, receipt of a bloodtransfusion prior to 1992, receiving maintenance hemodialysis, OR birthdate in the years 1945–1965


DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under theMedicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in thedenominator population for registry-based measures.


Denominator Criteria (Eligible Cases): Patients aged ≥ 18 years

AND At least one preventive encounter during the performance period (CPT or HCPCS): 99385*, 99386*,99387*, 99395*, 99396*, 99397*, G0438, G0439

WITHOUT:Telehealth Modifier: GQ, GT, 95, POS 02

OR 

At least two patient encounters during the performance period (CPT): 99201, 99202, 99203, 99204,99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*, 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


WITHOUT: 

Telehealth Modifier: GQ, GT, 95, POS 02

AND 

 Patients who were born in the years 1945 to 1965: G9448

OR

History of receiving blood transfusions prior to 1992: G9449

OR

Receiving maintenance hemodialysis (CPT): 90951, 90952, 90953, 90954, 90955, 90956, 90957, 90958,90959, 90960, 90961, 90962, 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 99512*

OR

History of injection drug use: G9450

AND NOT

DENOMINATOR EXCLUSION: Diagnosis for Chronic Hepatitis C (ICD-10-CM): B18.2


NUMERATOR: Patients who received one-time screening for HCV infection

NUMERATOR NOTE: Denominator Exception(s) are determined on the date of the most recent denominator eligibleencounter.


Definition:
Screening for HCV Infection includes current or prior receipt of:

1. HCV antibody test

2. HCV RNA test

3. Recombinant immunoblot assay (RIBA) test (if performed at any time in the past)


Numerator Options:

Performance Met: Patient received one-time screening for HCV infection(G9451)

OR

Denominator Exception: Documentation of medical reason(s) for not receivingone-time screening for HCV infection (e.g.,decompensated cirrhosis indicating advanceddisease [i.e., ascites, esophageal variceal bleeding,hepatic encephalopathy], hepatocellular carcinoma,waitlist for organ transplant, limited life expectancy,other medical reasons) (G9452)ORDenominator Exception: Documentation of patient reason(s) for not receivingone-time screening for HCV infection (e.g., patientdeclined, other patient reasons) (G9453)ORPerformance Not Met: One-time screening for HCV infection not receivedwithin 12 month reporting period and nodocumentation of prior screening for HCV infection,reason not given (G9454)