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Measure: CMS125

Breast Cancer Screening

Measure Versions

eMeasure Code Measure Year Full Version Number Title
CMS125v9 2021 9.2.000 Breast Cancer Screening
CMS125v8 2020 8.4.000 Breast Cancer Screening
CMS125v7 2019 7.2.000 Breast Cancer Screening
CMS125v6 2018 6.2.000 Breast Cancer Screening
CMS125v5 2017 5.0.000 Breast Cancer Screening

Description

Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer

Guidance

None

Patient Group Definitions

Group Description Instructions Links
Initial PopulationWomen 51-74 years of age with a visit during the measurement periodWebchart Instructions
DenominatorEquals Initial PopulationWebchart Instructions
Denominator ExclusionsWomen who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomyWebchart Instructions
NumeratorWomen with one or more mammograms during the measurement period or the 15 months prior to the measurement periodWebchart Instructions
Numerator ExclusionsNot ApplicableWebchart Instructions
Denominator ExceptionsNone

Details

Full eMeasure Code eMeasure Identifier Measure Year Version NQF # GUID
CMS125v5 125 2017 5.0.000 2372 19783c1b-4fd1-46c1-8a96-a2f192b97ee0
Steward Developer Endorsed By
National Committee for Quality Assurance National Committee for Quality Assurance National Quality Forum
Scoring Method Measure Type Stratification Risk Adjustment
Proportion PROCESS None None

Rate Aggregation

None

Improvement Notation

Higher score equals better quality

Rationale

Breast cancer is one of the most common types of cancers, accounting for a quarter of all new cancer diagnoses for women in the U.S. (BreastCancer.Org, 2011). It ranks as the second leading cause of cancer-related mortality in women, accounting for nearly 40,000 estimated deaths in 2013 (American Cancer Society, 2011). According to the National Cancer Institute's Surveillance Epidemiology and End Results program, the chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 30, it is one in 2,212. By age 40, the chances increase to one in 235, by age 50, it becomes one in 54, and, by age 60, it is one in 25. From 2004 to 2008, the median age at the time of breast cancer diagnosis was 61 years among adult women (Tangka et al, 2010). In the U.S., costs associated with a diagnosis of breast cancer range from $451 to $2,520, factoring in continued testing, multiple office visits and varying procedures. The total costs related to breast cancer add up to nearly $7 billion per year in the U.S., including $2 billion spent on late-stage treatment (Lavigne et al, 2008; Boykoff et al, 2009).

Clinical Recommendation Statement

The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50-74 years (B recommendation). The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms (C recommendation). (USPSTF, 2009) The Task Force concludes the evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years and older (I statement). 
U.S. Preventive Services Task Force (2009)
Grade: B recommendation. The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
Grade: C recommendation. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.
Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.
Grade: D recommendation. The USPSTF recommends against teaching breast self-examination (BSE).
Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.
Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.

Definition

None

Transmission Format

TBD

Applicable Value Sets

Category Value Set OID
Diagnosis History of bilateral mastectomy 2.16.840.1.113883.3.464.1003.198.12.1068
Diagnosis Left Mastectomy 2.16.840.1.113883.3.464.1003.198.12.1069
Diagnosis Right Mastectomy 2.16.840.1.113883.3.464.1003.198.12.1070
Diagnosis Unilateral Mastectomy, Unspecified Laterality 2.16.840.1.113883.3.464.1003.198.12.1071
Diagnostic Study, Performed Mammogram 2.16.840.1.113883.3.464.1003.108.12.1018
Encounter, Performed Annual Wellness Visit 2.16.840.1.113883.3.526.3.1240
Encounter, Performed Face-to-Face Interaction 2.16.840.1.113883.3.464.1003.101.12.1048
Encounter, Performed Home Healthcare Services 2.16.840.1.113883.3.464.1003.101.12.1016
Encounter, Performed Office Visit 2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed Preventive Care Services - Established Office Visit, 18 and Up 2.16.840.1.113883.3.464.1003.101.12.1025
Encounter, Performed Preventive Care Services-Initial Office Visit, 18 and Up 2.16.840.1.113883.3.464.1003.101.12.1023
Patient Characteristic Ethnicity Ethnicity 2.16.840.1.114222.4.11.837
Patient Characteristic Payer Payer 2.16.840.1.114222.4.11.3591
Patient Characteristic Race Race 2.16.840.1.114222.4.11.836
Patient Characteristic Sex Female 2.16.840.1.113883.3.560.100.2
Patient Characteristic Sex ONC Administrative Sex 2.16.840.1.113762.1.4.1
Procedure, Performed Bilateral Mastectomy 2.16.840.1.113883.3.464.1003.198.12.1005
Procedure, Performed Unilateral Mastectomy 2.16.840.1.113883.3.464.1003.198.12.1020

References

American Cancer Society. 2010. Cancer Facts & Figures 2010. Atlanta: American Cancer Society.
National Cancer Institute. 2010. "Breast Cancer Screening." http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional
National Business Group on Health. 2011. Pathways to Managing Cancer in the Workplace. Washington: National Business Group on Health.
U.S. Preventive Services Task Force (USPSTF). 2009. 1) "Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement." 2) "December 2009 addendum." Ann Intern Med 151(10):716-726.
BreastCancer.org. 2012. U.S. Breast Cancer Statistics. www.breastcancer.org/symptoms/understand_bc/statistics.jsp

Disclaimer

These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Copyright

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Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2015 American Medical Association. LOINC(R) copyright 2004-2015 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2015 International Health Terminology Standards Development Organisation. ICD-10 copyright 2015 World Health Organization. All Rights Reserved.

Source: https://ecqi.healthit.gov/ecqm/measures/cms125v5