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Measure: CMS125

Breast Cancer Screening

Measure Versions

eMeasure Code Measure Year Full Version Number Title
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 in the 27 months prior to the end of the Measurement Period

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. This eCQM is a patient-based measure.   This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

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 mastectomy. Exclude patients whose hospice care overlaps the measurement period. Exclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period. Exclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured.Webchart Instructions
NumeratorWomen with one or more mammograms during the 27 months prior to the end of the measurement periodWebchart Instructions
Numerator ExclusionsNot ApplicableWebchart Instructions
Denominator ExceptionsNone

Details

Full eMeasure Code eMeasure Identifier Measure Year Version NQF # GUID
CMS125v9 2021 9.2.000 Not Applicable 19783c1b-4fd1-46c1-8a96-a2f192b97ee0
Steward Developer Endorsed By
National Committee for Quality Assurance National Committee for Quality Assurance
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. (Noone et al, 2018). In 2015, 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 (Noone et al, 2018). 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 (Noone et al, 2018). 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 68; by age 50 it becomes 1 in 43; by age 60, it is 1 in 29 (American Cancer Society, 2017).

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 Frailty Diagnosis 2.16.840.1.113883.3.464.1003.113.12.1074
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 Acute Inpatient 2.16.840.1.113883.3.464.1003.101.12.1083
Encounter, Performed Annual Wellness Visit 2.16.840.1.113883.3.526.3.1240
Encounter, Performed Care Services in Long-Term Residential Facility 2.16.840.1.113883.3.464.1003.101.12.1014
Encounter, Performed ED 2.16.840.1.113883.3.464.1003.101.12.1085
Encounter, Performed Encounter Inpatient 2.16.840.1.113883.3.666.5.307
Encounter, Performed Frailty Encounter 2.16.840.1.113883.3.464.1003.101.12.1088
Encounter, Performed Home Healthcare Services 2.16.840.1.113883.3.464.1003.101.12.1016
Encounter, Performed Nonacute Inpatient 2.16.840.1.113883.3.464.1003.101.12.1084
Encounter, Performed Nursing Facility Visit 2.16.840.1.113883.3.464.1003.101.12.1012
Encounter, Performed Observation 2.16.840.1.113883.3.464.1003.101.12.1086
Encounter, Performed Office Visit 2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed Outpatient 2.16.840.1.113883.3.464.1003.101.12.1087
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
Medication, Active Dementia Medications 2.16.840.1.113883.3.464.1003.196.12.1510
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 Left 2.16.840.1.113883.3.464.1003.198.12.1133
Procedure, Performed Unilateral Mastectomy Right 2.16.840.1.113883.3.464.1003.198.12.1134
Symptom Frailty Symptom 2.16.840.1.113883.3.464.1003.113.12.1075

References

American Cancer Society. 2017. “Breast Cancer Facts & Figures 2017-2018.” (February 8, 2019). Retrieved from https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2017-2018.pdf
Noone, A.M., Howlader, N., Krapcho, M., Miller, D., Brest, A., Yu, M., Ruhl, J., Tatalovich, Z., Mariotto, A., Lewis, D.R., Chen, H.S., Feuer, E.J., Cronin, K.A. (eds). 2018. “SEER Cancer Statistics Review, 1975-2015.” National Cancer Institute. Bethesda, MD. (February 8, 2019) Retrieved from https://seer.cancer.gov/csr/1975_2015/
U.S. Preventive Services Task Force. (2016). Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 164(4), 279-296.

Disclaimer

The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE 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

This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2019 National Committee for Quality Assurance. All Rights Reserved. 

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 third party codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2019 American Medical Association. LOINC(R) copyright 2004-2019 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2019 International Health Terminology Standards Development Organisation. ICD-10 copyright 2019 World Health Organization. All Rights Reserved.

Source: https://ecqi.healthit.gov/ecqm/measures/cmsv9