Uploaded image for project: 'eCQM Issue Tracker'
  1. eCQM Issue Tracker
  2. CQM-6987

CMS 130: G0402 is not included as an eligible encounter

XMLWordPrintable

    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Icon: Moderate Moderate
    • None
    • None
    • Megan Reilly
    • Hide
      Thank you for your inquiry about CMS130v11 and CMS130v12 Colorectal Cancer Screening.

      Value sets once published cannot be updated, please note that HCPCS Level II code G0402 is included in the "Annual Wellness Visit" (OID 2.16.840.1.113883.3.526.3.1240) published May 2nd, 2024 (for use in PY2025) . You can reference the applicable codes containing these value sets on the Value Set Authority Center (VSAC) https://vsac.nlm.nih.gov/ or you can find the value set using the 2024-05-02 expansion file in the link below: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion/eCQM%20Update%202024-05-02 .

      Clinically equivalent services may be mapped to the codes used in a measure's value sets to satisfy the numerator requirement. We are unable to provide specific guidance related to the mapping of codes. We recommend you consult with your EHR vendor and clinical partners. If mapping is conducted, you should maintain documentation in case of a CMS audit.
      Show
      Thank you for your inquiry about CMS130v11 and CMS130v12 Colorectal Cancer Screening. Value sets once published cannot be updated, please note that HCPCS Level II code G0402 is included in the "Annual Wellness Visit" (OID 2.16.840.1.113883.3.526.3.1240) published May 2nd, 2024 (for use in PY2025) . You can reference the applicable codes containing these value sets on the Value Set Authority Center (VSAC) https://vsac.nlm.nih.gov/ or you can find the value set using the 2024-05-02 expansion file in the link below: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion/eCQM%20Update%202024-05-02 . Clinically equivalent services may be mapped to the codes used in a measure's value sets to satisfy the numerator requirement. We are unable to provide specific guidance related to the mapping of codes. We recommend you consult with your EHR vendor and clinical partners. If mapping is conducted, you should maintain documentation in case of a CMS audit.
    • CMS0130v12
    • CMS0130v11
    • Denominators are lower than expected - G0402 should be included in qualifying encounters.

      G0402 Medicare code is used for preventative visits and should be included as an eligible outpatient encounter but rather it is currently only being used to look for exclusions impacting the qualifying denominator to be lower than it should be. 

            edave Mathematica EC eCQM Team
            megan.reilly@contexture.org Megan Reilly (Inactive)
            Votes:
            0 Vote for this issue
            Watchers:
            4 Start watching this issue

              Created:
              Updated:
              Resolved:
              Solution Posted On: