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  2. CQM-7559

Questions about CMS128v13

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
    • Resolution: Answered
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    • Nathaniel Bell
    • 2066611728
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      Thank you for your inquiry regarding CMS128v13 (2025 Performance Period). Below are the responses to the hypothetical scenarios provided.

      1. The patient is included in the denominator if diagnosed with major depression within 60 days before or after the Index Prescription Start Date (IPSD) and dispensed antidepressant medications during the Intake Period, even if the diagnosis is later revised to another condition during the measurement period. The initial diagnosis of major depression meets the criteria for denominator inclusion, provided the patient also had a qualifying encounter within 60 days of the IPSD.
      2. The patient remains in the denominator if diagnosed with major depression within 60 days before or after the IPSD and had a qualifying encounter, regardless of the remission status.
      3. The custom sig qualifies for the measure if the prescribed frequency and duration meet treatment requirements. The `CMD.CodeToDaily` and `CMD.QuantityToDaily` functions convert the frequency into daily doses, while `CMD.MedicationDispensedPeriod` calculates the medication's supply duration. If the continuous treatment period meets the minimum required (84 days for Numerator 1, 180 days for Numerator 2), the custom sig will qualify.
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      Thank you for your inquiry regarding CMS128v13 (2025 Performance Period). Below are the responses to the hypothetical scenarios provided. 1. The patient is included in the denominator if diagnosed with major depression within 60 days before or after the Index Prescription Start Date (IPSD) and dispensed antidepressant medications during the Intake Period, even if the diagnosis is later revised to another condition during the measurement period. The initial diagnosis of major depression meets the criteria for denominator inclusion, provided the patient also had a qualifying encounter within 60 days of the IPSD. 2. The patient remains in the denominator if diagnosed with major depression within 60 days before or after the IPSD and had a qualifying encounter, regardless of the remission status. 3. The custom sig qualifies for the measure if the prescribed frequency and duration meet treatment requirements. The `CMD.CodeToDaily` and `CMD.QuantityToDaily` functions convert the frequency into daily doses, while `CMD.MedicationDispensedPeriod` calculates the medication's supply duration. If the continuous treatment period meets the minimum required (84 days for Numerator 1, 180 days for Numerator 2), the custom sig will qualify.
    • CMS0128v13
    • CMS0128v12
    • Some detailed questions about how certain data would impact how this measure would be processed.

      I have a few questions regarding how certain data will impact the CMS128v13 measure.

      1. If during a measurement period, a patient initially receives a diagnosis of major depression, but later during the same measurement period that diagnosis is removed or revised to something else (PTSD or bipolar for example), will the patient still be included in the denominator for this measure?
      2. If a diagnosis of major depression is updated to "in remission" during the measurement period, are they still counted in the denominator? (I am trying to account for a hypothetical situation in which a patient's depression improves, presumably for reasons other than responding to the medication, and they decide to stop taking the medication.)
      3. How is a custom sig on a prescription dealt with? For example, a medication could be taken twice daily and thus a quantity of 60 be provided to last 30 days. If this was captured in a custom sig, how would it know the difference? Do prescriptions need to include a "number of days" to count toward satisfying?

      Thank you!

            AIR EC eCQM Team AIR EC eCQM Team
            nbell69 Nathaniel
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