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July 2021 Quest Details

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CMS Approves Suppressing Quality ID 001: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) and Quality ID 117: Diabetes: Eye Exam Medicare Part B Claims submissions for the 2021 Performance Period

The Centers for Medicare & Medicaid Services (CMS) will suppress the Medicare Part B claims-based submission of the following measures for the 2021 performance period:  

  • Quality ID (QID) 001: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
  • QID 117: Diabetes: Eye Exam

In January 2021, new Current Procedural Terminology (CPT) Category II Quality Data Codes were introduced as numerator options within the measure specification but were not activated within CMS systems and therefore not usable for the 2021 performance period. Stakeholders expressed concerns that reporting these codes has resulted in rejected claims due to the inactive status.

Measure QID Measure Name Affected CPT II Quality Data Code
001 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) 3051F - Most recent hemoglobin A1c (HbA1c) level greater than or equal to 7.0% and less than 8.0%
001 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) 3052F - Most recent hemoglobin A1c (HbA1c) level greater than or equal to 8.0% and less than or equal to 9.0%
117 Diabetes Eye Exam 2023F - Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy
117 Diabetes Eye Exam 2025F - 7 standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy
117 Diabetes Eye Exam 2033F - Eye imaging validated to match diagnosis from  7 standard field stereoscopic photos results documented and reviewed, without evidence of retinopathy

Per CMS policy:

For each measure that is submitted, if applicable, and impacted by significant changes, performance is based on data for 9 consecutive months of the applicable CY performance period. If such data are not available or may result in patient harm or misleading results, the measure is excluded from a MIPS eligible clinician's total measure achievement points and total available measure achievement points. For purposes of this paragraph (b)(1)(vii)(A), “significant changes” means changes to a measure that are outside the control of the clinician and its agents and that CMS determines may result in patient harm or misleading results. Significant changes include, but are not limited to, changes to codes (such as ICD-10, CPT, or HCPCS codes), clinical guidelines, or measure specifications. CMS will publish on the CMS website a list of all measures scored under this paragraph (b)(1)(vii)(A) as soon as technically feasible, but by no later than the beginning of the data submission period at § 414.1325(e)(1).

Therefore, CMS is suppressing the Medicare Part B claims collection type for QID 001 and QID 117 for the 2021 performance period, and these measures will not be scored. For each suppressed measure that’s submitted for the 2021 performance period, the total available measure achievement points will be reduced by 10 points*. CMS encourages eligible clinicians and groups to choose different quality measures to report for the 2021 performance period. MIPS-eligible clinicians do not need to submit any additional documentation or resubmit rejected claims solely for the purpose of adding a quality data code for the 2021 performance period.

For any questions related to this policy, please contact the Quality Payment Program at 1.866.288.8292 or by email at QPP@cms.hhs.gov (Monday-Friday 8 a.m.–8 p.m. ET). To receive assistance more quickly, please consider calling during non-peak hours—before 10:00 a.m. and after 2:00 p.m. ET. Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.

*Please refer to the scoring equations on page 43 of the 2021 MIPS Quality User Guide https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1432/2021%20MIPS%20Quality%20User%20Guide.pdf.