The denominator for QPP 501 has a requirement for an “acute vitreous hemorrhage” HCPCS code (M1333), but no such code is required for QPP 500 (similar ASRS measure), even for the same elements. Practices have noted to Verana Health that this HCPCS code does not exist in their data and have asked how to proceed.

AAO discussed this topic with ASRS, and they recommend ignoring the "AND" criteria in the QPP 501 denominator specifications so that the HCPCS code would not be required in addition to the ICD10 and CPT codes. However, we'd like to confirm with CMS whether we should move forward with this interpretation of the measure. To clarify, if we do implement the HCPCS code for the denominator, we do not have any qualifying patients for the denominator of this measure across practices.

Please advise how we should proceed.

Thanks, 

Emily Lang (Verana Health)