Question on intent of measure steward and interpretation of results by payer on Kidney Health Evaluation

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
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      Thank you for your injury on CMS951v3: Kidney Health Evaluation. The 2025 measure includes patients who received a kidney health evaluation which is defined by the performance and resulting of an eGFR AND uACR during the measurement period. The only timing constraint applied to these two data elements is that they be resulted within the measurement period; nothing requires them to be occurring on the same day.
       
      The 2026 measure specs were updated to include a new combination of urine tests that could be used in place of a uACR to allow some flexibility in the numerator - a urine albumin and urine creatinine performed within 4 days of each other during the measurement period.
      The requirements of the eGFR and uACR remain unchanged – requiring each to be resulted during the measurement period.
       
      To summarize the logic:
      eGFR resulted during measurement period
      AND
      uACR resulted during measurement period
      or
      urine albumin and urine creatinine performed within 4 days of each other during the measurement period
      Show
      Thank you for your injury on CMS951v3: Kidney Health Evaluation. The 2025 measure includes patients who received a kidney health evaluation which is defined by the performance and resulting of an eGFR AND uACR during the measurement period. The only timing constraint applied to these two data elements is that they be resulted within the measurement period; nothing requires them to be occurring on the same day.   The 2026 measure specs were updated to include a new combination of urine tests that could be used in place of a uACR to allow some flexibility in the numerator - a urine albumin and urine creatinine performed within 4 days of each other during the measurement period. The requirements of the eGFR and uACR remain unchanged – requiring each to be resulted during the measurement period.   To summarize the logic: eGFR resulted during measurement period AND uACR resulted during measurement period or urine albumin and urine creatinine performed within 4 days of each other during the measurement period
    • CMS0951v3

      I have heard from at least one payer that they are interpreting an applicable patient with an eGFR and a uACR resulted on different days as NOT MET. My read of the 2025 measure specs is that an eGFR and a uACR need to be done during the measure period, and that there is no requirement that they be performed on the same day.

      Further, when reviewing the 2026 specs, I see that additional flexibility is being added to the 2025 specs, in that in addition to the uACR and eGFR resulted during the measure period, a urine albumin and urine creatinine done on the same specimen and resulted within 4 days of each other will also count as MET.

      Can you please clarify result timing of both the eGFR and uACR for 2025, and what is specified for 2026. Thank you

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Peter Basch
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