Measure: CMS249
Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture
Measure Versions
| eMeasure Code | Measure Year | Full Version Number | Title |
|---|---|---|---|
| CMS249v6 | 2024 | 6.0.000 | Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture |
| CMS249v5 | 2023 | 5 | Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture |
| CMS249v4 | 2022 | 4.0.000 | Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture |
| CMS249v3 | 2021 | 3.2.000 | Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture |
| CMS249v2 | 2020 | 2.4.000 | Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture |
| CMS249v1 | 2019 | 1.4.000 | Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture |
Description
Percentage of female patients 50 to 64 years of age without select risk factors for osteoporotic fracture who received an order for a dual-energy x-ray absorptiometry (DXA) scan during the measurement period.Guidance
Patient Group Definitions
| Group | Description | Instructions Links |
|---|---|---|
| Initial Population | Female patients ages 50 to 63 years at the start of the measurement period with an encounter during the measurement period | Webchart Instructions |
| Denominator | Equals Initial Population | Webchart Instructions |
| Denominator Exclusions | Exclude patients with one of the following risk factors. Risk factors are grouped by when they occur in relation to the measurement period. The following risk factors must be active during the measurement period: BMI <= 20 kg/m2 (must be the first BMI of the measurement period) Alcohol consumption (> two units per day (one unit is 12 oz. of beer, 4 oz. of wine, or 1 oz. of liquor)) The following risk factors may occur at any time in the patient's history prior to the start of the measurement period: Osteoporosis Osteopenia The following risk factors may occur at any time in the patient's history prior to the start of the measurement period, but do not need to be active during the measurement period: Gastric bypass Aromatase inhibitors Documentation of history of hip fracture in parent The following risk factors may occur at any time in the patient's history or during the measurement period: Glucocorticoids [cumulative medication duration >= 90 days] Osteoporotic fracture Malabsorption Syndromes: celiac disease, inflammatory bowel disease, ulcerative colitis, Crohn's disease, cystic fibrosis, malabsorption Chronic malnutrition Chronic liver disease Rheumatoid arthritis Hyperthyroidism Type I Diabetes End stage renal disease Osteogenesis imperfecta Ankylosing spondylitis Psoriatic arthritis Ehlers-Danlos syndrome Cushing's syndrome Hyperparathyroidism Marfan syndrome Lupus Chemotherapy Multiple myeloma Premature menopause Double or bilateral oophorectomy Eating disorder Amenorrhea Organ transplant | Webchart Instructions |
| Numerator | Female patients who received an order for at least one DXA scan in the measurement period | Webchart Instructions |
| Numerator Exclusions | Exclude patients with a result on one of the following tools, which indicates the patient should be considered for bone density testing, anytime in the patient’s history prior to the time of the first DXA scan during the measurement period: FRAX[R] ten-year probability of all major osteoporosis related fracture >= 8.4 percent ORAI score of >=9 OSIRIS score of <1 OST score of <2 | Webchart Instructions |
| Denominator Exceptions | None |
Details
| Full eMeasure Code | eMeasure Identifier | Measure Year | Version | NQF # | GUID |
|---|---|---|---|---|---|
| CMS249v5 | 249 | 2023 | 5 | N/A | a3ce125d-c238-42ce-862e-dba0055dfc66 |
| Steward | Developer | Endorsed By |
|---|---|---|
| Centers for Medicare & Medicaid Services (CMS) | National Committee for Quality Assurance | National Quality Forum |
| Scoring Method | Measure Type | Stratification | Risk Adjustment |
|---|---|---|---|
| Proportion | Process | None | None |
Rate Aggregation
None
Improvement Notation
Lower score indicates better qualityRationale
Clinical Recommendation Statement
Definition
Transmission Format
Applicable Value Sets
| Category | Value Set | OID |
|---|---|---|
| Assessment, Performed | History of hip fracture in parent | 2.16.840.1.113883.3.464.1003.113.12.1040 |
| Diagnosis | Amenorrhea | 2.16.840.1.113883.3.464.1003.1022 |
| Diagnosis | Ankylosing Spondylitis | 2.16.840.1.113883.3.464.1003.113.12.1045 |
| Diagnosis | Chronic Liver Disease | 2.16.840.1.113883.3.464.1003.199.12.1035 |
| Diagnosis | Chronic Malnutrition | 2.16.840.1.113883.3.464.1003.199.12.1036 |
| Diagnosis | Cushings Syndrome | 2.16.840.1.113883.3.464.1003.117.12.1009 |
| Diagnosis | Eating Disorders | 2.16.840.1.113883.3.464.1003.1039 |
| Diagnosis | Ehlers Danlos Syndrome | 2.16.840.1.113883.3.464.1003.113.12.1047 |
| Diagnosis | End Stage Renal Disease | 2.16.840.1.113883.3.526.3.353 |
| Diagnosis | Hyperparathyroidism | 2.16.840.1.113883.3.464.1003.117.12.1016 |
| Diagnosis | Hyperthyroidism | 2.16.840.1.113883.3.464.1003.117.12.1015 |
| Diagnosis | Lupus | 2.16.840.1.113883.3.464.1003.117.12.1010 |
| Diagnosis | Malabsorption Syndromes | 2.16.840.1.113883.3.464.1003.199.12.1050 |
| Diagnosis | Marfan's Syndrome | 2.16.840.1.113883.3.464.1003.113.12.1048 |
| Diagnosis | Multiple Myeloma | 2.16.840.1.113883.3.464.1003.1011 |
| Diagnosis | Osteogenesis Imperfecta | 2.16.840.1.113883.3.464.1003.113.12.1044 |
| Diagnosis | Osteopenia | 2.16.840.1.113883.3.464.1003.113.12.1049 |
| Diagnosis | Osteoporosis | 2.16.840.1.113883.3.464.1003.113.12.1038 |
| Diagnosis | Osteoporotic Fractures | 2.16.840.1.113883.3.464.1003.113.12.1050 |
| Diagnosis | Premature Menopause | 2.16.840.1.113883.3.464.1003.1013 |
| Diagnosis | Psoriatic Arthritis | 2.16.840.1.113883.3.464.1003.113.12.1046 |
| Diagnosis | Rheumatoid Arthritis | 2.16.840.1.113883.3.464.1003.113.12.1005 |
| Diagnosis | Type 1 Diabetes | 2.16.840.1.113883.3.464.1003.103.12.1020 |
| Diagnostic Study, Order | DXA (Dual energy Xray Absorptiometry) Scan | 2.16.840.1.113883.3.464.1003.113.12.1051 |
| Encounter, Performed | Office Visit | 2.16.840.1.113883.3.464.1003.101.12.1001 |
| Encounter, Performed | Online Assessments | 2.16.840.1.113883.3.464.1003.101.12.1089 |
| Encounter, Performed | Outpatient Consultation | 2.16.840.1.113883.3.464.1003.101.12.1008 |
| 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 |
| Encounter, Performed | Telephone Visits | 2.16.840.1.113883.3.464.1003.101.12.1080 |
| Medication, Active | Aromatase Inhibitors | 2.16.840.1.113883.3.464.1003.196.12.1265 |
| Medication, Active | Glucocorticoids (oral only) | 2.16.840.1.113883.3.464.1003.196.12.1266 |
| Medication, Order | Aromatase Inhibitors | 2.16.840.1.113883.3.464.1003.196.12.1265 |
| 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 | ONC Administrative Sex | 2.16.840.1.113762.1.4.1 |
| Procedure, Performed | Bilateral Oophorectomy | 2.16.840.1.113883.3.526.3.471 |
| Procedure, Performed | Bone Marrow Transplant | 2.16.840.1.113883.3.666.5.336 |
| Procedure, Performed | Chemotherapy | 2.16.840.1.113883.3.526.3.485 |
| Procedure, Performed | Evidence of Bilateral Oophorectomy | 2.16.840.1.113883.3.464.1003.1048 |
| Procedure, Performed | Gastric Bypass Surgery | 2.16.840.1.113883.3.464.1003.198.12.1050 |
| Procedure, Performed | Kidney Transplant | 2.16.840.1.113883.3.464.1003.109.12.1012 |
| Procedure, Performed | Major Transplant | 2.16.840.1.113883.3.464.1003.198.12.1075 |
| Procedure, Performed | Unilateral Oophorectomy Left | 2.16.840.1.113883.3.464.1003.1028 |
| Procedure, Performed | Unilateral Oophorectomy Right | 2.16.840.1.113883.3.464.1003.1032 |
| Procedure, Performed | Unilateral Oophorectomy, Unspecified Laterality | 2.16.840.1.113883.3.464.1003.1035 |