​ Thank you for your question regarding CMS645v6: Bone density evaluation for patients with prostate cancer and receiving androgen deprivation therapy. The Denominator Exception is met by patient refusal of the bone density evaluation at the time of the order for the bone density scan or met by patient refusal of the bone density scan within 3 months or less after the start of ADT. However, this does not imply that all cases not meeting the Numerator would meet the Denominator Exception because there must be documentation of the patient refusal of the bone density scan to meet the Denominator Exception.

Can you please clarify the denominator exception for MIPS 462. The description reads, "Patient refused the bone density evaluation at the time ordered or did not not have it performed within 3 months after the start of ADT". This would imply that any patient that did not meet the numerator would be considered a denominator exception. Based on the more detailed denominator descriptions, it appears that the exception should be: 1) Patient refused at the time of the order or 2) patient had an order for a scan, but refused to have the scan performed within 3 months after the start of ADT. Can you please confirm that this is a correct interpretation of the denominator exception?