Description
Percentage of patients 18-75 years of age with diabetes who had a glycemic status assessment (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) > 9.0% during the measurement period.
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Measure Template
Field | Description |
|---|---|
Provider NPI | 10-digit NPI number related to this instance |
Provider TIN * | 9-digit TIN number related to this instance |
Patient ID * | Patient identifier from source system |
First Name * | Patient first name, used for de-duplication |
Last Name * | Patient last name, used for de-duplication |
Gender * | Patient gender |
Date of service, YYYY/MM/DD * | Service date for this instance, must be within reporting year |
Patient date of birth, YYYY/MM/DD * | Patient birth date |
Payer | Primary insurance payer Suggested values are: “Medicare Part B FFS” or “Other” |
Diagnosis code * | ICD-10 code for this instance |
Encounter code * | CPT/HCPCS code for this instance |
Hospice services provided to patient any time during the measurement period * | Must be TRUE if asserting G9687 exclusion Otherwise, must be FALSE |
Palliative care services provided to patient any time during the measurement period * | Must be TRUE if asserting G9988 exclusion Otherwise, must be FALSE |
Patients age 66 and older in Institutional Special Needs Plans (SNP) or residing in long-term care with a POS code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period * | Must be TRUE if asserting G2081 exclusion Otherwise, must be FALSE |
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND a dispensed medication for dementia during the measurement period or the year prior to the measurement period * | Must be TRUE if asserting G2090 exclusion Otherwise, must be FALSE |
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND an advanced illness diagnosis during the measurement period or the year prior to the measurement period * | Must be TRUE if asserting G2091 exclusion Otherwise, must be FALSE |
Measure 1_SSP * | Numerator response code for this instance - see acceptable codes below |
* Indicates a mandatory field
Numerator Response Codes
The table below defines the acceptable numerator response codes for measure 1.
Numerator Code | Performance | Description |
|---|---|---|
M1211 | Met | Most recent hemoglobin A1c level > 9.0% |
M1212 | Met | Hemoglobin A1c level was not performed during the measurement period (12 months) |
M1371 | Not Met | Most recent hemoglobin A1c (HbA1c) level < 7.0% |
M1372 | Not Met | Most recent hemoglobin A1c (HbA1c) level greater than or equal to 7.0% and less than 8.0% |
M1373 | Not Met | Most recent hemoglobin A1c (HbA1c) level greater than or equal to 8.0% and less than or equal to 9.0% |
G9687 | Exclusion | Hospice services provided to patient any time during the measurement period |
G9988 | Exclusion | Palliative care services provided to patient any time during the measurement period |
G2081 | Exclusion | Patients age 66 and older in Institutional Special Needs Plans (SNP) or residing in long-term care with a POS code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period |
G2090 | Exclusion | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
G2091 | Exclusion | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND an advanced illness diagnosis during the measurement period or the year prior to the measurement period |