Thank you for your inquiry regarding CMS125v13 (2025 Performance Period). This measure allows for a unilateral mammography to qualify as numerator compliant. You may use any code from the "Mammography" (2.16.840.1.113883.3.464.1003.108.12.1018) value set given that the mammogram was performed on or between October 1 two years prior to the measurement period and the end of the measurement period. Codes for unilateral mammograms are included and meet numerator criteria because women with a unilateral mastectomy remain in the measure and are expected to have screening (unilateral mammography). Clinically equivalent services may be mapped to the codes used in a measure's value sets to satisfy a value set requirement. If mapping is conducted, you should maintain documentation in case of a CMS audit.

CQM 2661 from several years ago acknowledged that the measure logic and value set coding were not specific enough to allow the numerator to be met by unilateral studies only on patients with a unilateral mastectomy. The result is that any patient who receives a unilateral mammogram will be in the numerator.