During a recent internal measure review of CMS 157, we identified that the inclusion of CPT code 96523, which represents port flushes and other non-chemotherapy therapeutic services, may unintentionally inflate both the denominator and numerator of the measure. This is particularly relevant for cancer patients who have completed active chemotherapy but continue to receive periodic infusaport maintenance, which represents a sizeable percentage of our cancer patients. Most cancer patients do not have their infusaport removed immediately after chemotherapy ends. There is a medically recommended waiting period to ensure stable remission/recovery, usually 6-12 months after completing chemotherapy, and sometimes up to 5 years for cancer at high risk of recurrence. Including 96523 in the value set results in these encounters being treated as active chemotherapy administration, thereby skewing performance calculations. 

In contrast, the CPT 964xx series accurately represents true chemotherapy administrations—such as IV, push, infusion, complex biologic administration, prolonged infusions, and pump initiation/management—while the 965xx series pertains to hydration, therapeutic infusions, and catheter care, which are not indicative of chemotherapy treatment.  Restricting the value set to codes representing true chemotherapy administration would strengthen the accuracy and clinical validity of the measure. 

We propose CMS update their value set “Chemotherapy Administration” (2.16.840.1.113883.3.526.3.1027) and remove CPT codes in the CPT 965xx range.