CMS 124 - Question regarding CPT codes for Pap tests and HPV tests

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      Thank you for your inquiry about the codes for CMS124v9, Cervical Cancer Screening. With regard to Question #1, the data criteria for 'HPV Test' and 'Pap Test' follows the CMS Measures Management System Blueprint's recommendations of using the LOINC code system for the clinical concept of 'Laboratory Test'. There is no other recommended code systems for the clinical concept or its QDM datatypes, which is why the value sets 'HPV Test' and "Pap Test" do not contain any CPT codes. Please find below links to the Blueprint for your reference. With regard to Question #2, equivalent services can be mapped to the measure's value sets. If mapping is done, you should maintain documentation in case of a CMS audit.

      Supplemental Material to the CMS MMS Blueprint, Codes, Code Systems, and Value Sets, Appendix. QDM Categories with ONC Health Information Technology Standards Committee (HITSC) Recommended Vocabularies: https://www.cms.gov/files/document/blueprint-codes-code-systems-value-sets.pdf#page=25
      CMS Measures Management System Blueprint Version 17.0: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/MMS-Blueprint
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      Thank you for your inquiry about the codes for CMS124v9, Cervical Cancer Screening. With regard to Question #1, the data criteria for 'HPV Test' and 'Pap Test' follows the CMS Measures Management System Blueprint's recommendations of using the LOINC code system for the clinical concept of 'Laboratory Test'. There is no other recommended code systems for the clinical concept or its QDM datatypes, which is why the value sets 'HPV Test' and "Pap Test" do not contain any CPT codes. Please find below links to the Blueprint for your reference. With regard to Question #2, equivalent services can be mapped to the measure's value sets. If mapping is done, you should maintain documentation in case of a CMS audit. Supplemental Material to the CMS MMS Blueprint, Codes, Code Systems, and Value Sets, Appendix. QDM Categories with ONC Health Information Technology Standards Committee (HITSC) Recommended Vocabularies: https://www.cms.gov/files/document/blueprint-codes-code-systems-value-sets.pdf#page=25 CMS Measures Management System Blueprint Version 17.0: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/MMS-Blueprint

      A client is requesting some clarification on CPT codes for Pap and HPV test codes used in CMS 124 measure logic for Measurement Period 2021. I have two questions. 

      Question 1: 
      What is the reasoning behind the following CPT codes being excluded from the HPV test valueset and PAP test valuesets?

      HPV test CPT codes: 

      87624 HPV, HIGH RISK WITH 16/18 GENOTYPE BY MOLECULAR ASSAY, SUREPATH
      87625 IADNA HUMAN PAPILLOMAVIRUS TYPES 16 & 18 ONLY

      Pap test CPT codes: 

      88141 cytopathology, cervical or vaginal [any reporting system]; requiring interpretation by physician
      88142 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation
      88143 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation
      88147 Cytopathology smears, cervical or vaginal
      88148  Cytopathology smears, cervical or vaginal
      88150 Cytopathology, slides, cervical or vaginal
      88152 cytopathology, slides, cervical or vaginal; with manual screening and computer-assisted rescreening under physician supervision
      88153 Cytopathology, slides, cervical or vaginal
      88164 Cytopathology, slides, cervical or vaginal (the Bethesda System)
      88165 Under Cytopathology Screening Procedures
      88166 Cytopathology, slides, cervical or vaginal (the Bethesda System
      88167 Cytopathology, slides, cervical or vaginal (the Bethesda System)
      88174 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation
      88175 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation

      Question 2: 

      If a client would like to account for these codes, would it appropriate to either 1) edit the measure logic to include these codes or 2) map the aforementioned codes to the valuesets/codes in the measure logic? 

      Best regards, 
      Varun Gregory

            Assignee:
            Mathematica EC eCQM Team (Inactive)
            Reporter:
            Varun Gregory (Inactive)
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