Measure: CMS125
Breast Cancer Screening
Measure Versions
eMeasure Code |
Measure Year |
Full Version Number |
Title |
CMS125v12 |
2024 |
12.0.000 |
Breast Cancer Screening |
CMS125v11 |
2023 |
11 |
Breast Cancer Screening |
CMS125v10 |
2022 |
10.0.000 |
Breast Cancer Screening |
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
Patient self-report for procedures as well as diagnostic studies should be recorded in 'Procedure, Performed' template or 'Diagnostic Study, Performed' template in QRDA-1.
This measure evaluates primary screening. Do not count biopsies, breast ultrasounds, or MRIs because they are not appropriate methods for primary breast cancer screening.
Patient Group Definitions
Group |
Description |
Instructions Links |
Initial Population | Women 51-74 years of age with a visit during the measurement period | Webchart Instructions |
Denominator | Equals Initial Population | Webchart Instructions |
Denominator Exclusions | Women 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 mastectomy.
Exclude patients whose hospice care overlaps the measurement period. | Webchart Instructions |
Numerator | Women with one or more mammograms during the measurement period or the 15 months prior to the measurement period | Webchart Instructions |
Numerator Exclusions | Not Applicable | Webchart Instructions |
Denominator Exceptions | None | |
Details
Full eMeasure Code |
eMeasure Identifier |
Measure Year |
Version |
NQF # |
GUID |
CMS125v7 |
125 |
2019 |
7.2.000 |
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 15 percent of all new cancer diagnoses in the U.S. (Howlader et al, 2016). In 2013, over 3 million women were estimated to be living with breast cancer in the U.S. and it is estimated that 12 percent of women will be diagnosed with breast cancer at some point during their lifetime (Howlader et al, 2016).
While there are other factors that affect a woman's risk of developing breast cancer, advancing age is a primary risk factor. Breast cancer is most frequently diagnosed among women ages 55-64; the median age at diagnosis is 62 years (Howlader et al, 2016). The chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 40, the chances are 1 in 235; by age 50 it becomes 1 in 54; by age 60, it is 1 in 25 (National Business Group on Health, 2011).
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 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 (National Business Group on Health, 2011). If breast cancer is detected through mammography screening and diagnosed in its earliest stages, treatment may be less expensive (Feig, 2011).
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 screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years (C recommendation). (USPSTF, 2016)
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older (I statement). (USPSTF, 2016)
The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer (I Statement). (USPSTF, 2016)
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, magnetic resonance imaging, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram (I statement). (USPSTF, 2016)
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 |
Encounter Inpatient |
2.16.840.1.113883.3.666.5.307 |
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 |
Intervention, Order |
Hospice care ambulatory |
2.16.840.1.113762.1.4.1108.15 |
Intervention, Performed |
Hospice care ambulatory |
2.16.840.1.113762.1.4.1108.15 |
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
Howlader, N., Noone, A.M., Krapcho, M., Miller, D., Bishop, K., Altekruse, S.F., Kosary, C.L., Yu, M., Ruhl, J., Tatalovich, Z., Mariotto, A., Lewis, D.R., Chen, H.S., Feuer, E.J., and Cronin, K.A. 2016. "SEER Cancer Statistics Review, 1975-2013." National Cancer Institute. (December 5, 2016) http://seer.cancer.gov/csr/1975_2013/
National Business Group on Health. 2011. "Pathways to Managing Cancer in the Workplace." (May 8, 2012). http://www.tcyh.org/employers/downloads/Pathways_Managing_Cancer_2011.pdf
Feig S. 2011. Comparison of Costs and Benefits of Breast Cancer Screening with Mammography, Ultrasonagraphy, and MRI. Obstetrics and Gynecology Clinics of North America. 38(1):179-96.
U.S. Preventive Services Task Force (USPSTF). 2016. "Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement." Ann Intern Med. 164(4):279-296. doi:10.7326/M15-2886.
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Source:
https://ecqi.healthit.gov/ecqm/measures/cms125v7