[CQM-5535] CMS 124 - Question regarding CPT codes for Pap tests and HPV tests Created: 08/25/22  Updated: 09/09/22  Resolved: 09/09/22

Status: Closed
Project: eCQM Issue Tracker
Component/s: None

Type: Other Priority: Moderate
Reporter: Varun Gregory (Inactive) Assignee: Mathematica EC eCQM Team (Inactive)
Resolution: Answered Votes: 0
Labels: None

Solution: Thank you for your inquiry about the codes for CMS124v9, Cervical Cancer Screening. With regard to Question #1, the data criteria for 'HPV Test' and 'Pap Test' follows the CMS Measures Management System Blueprint's recommendations of using the LOINC code system for the clinical concept of 'Laboratory Test'. There is no other recommended code systems for the clinical concept or its QDM datatypes, which is why the value sets 'HPV Test' and "Pap Test" do not contain any CPT codes. Please find below links to the Blueprint for your reference. With regard to Question #2, equivalent services can be mapped to the measure's value sets. If mapping is done, you should maintain documentation in case of a CMS audit.

Supplemental Material to the CMS MMS Blueprint, Codes, Code Systems, and Value Sets, Appendix. QDM Categories with ONC Health Information Technology Standards Committee (HITSC) Recommended Vocabularies: https://www.cms.gov/files/document/blueprint-codes-code-systems-value-sets.pdf#page=25
CMS Measures Management System Blueprint Version 17.0: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/MMS-Blueprint
Solution Posted On:

 Description   

A client is requesting some clarification on CPT codes for Pap and HPV test codes used in CMS 124 measure logic for Measurement Period 2021. I have two questions. 

Question 1: 
What is the reasoning behind the following CPT codes being excluded from the HPV test valueset and PAP test valuesets?

HPV test CPT codes: 

87624 HPV, HIGH RISK WITH 16/18 GENOTYPE BY MOLECULAR ASSAY, SUREPATH
87625 IADNA HUMAN PAPILLOMAVIRUS TYPES 16 & 18 ONLY

Pap test CPT codes: 

88141 cytopathology, cervical or vaginal [any reporting system]; requiring interpretation by physician
88142 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation
88143 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation
88147 Cytopathology smears, cervical or vaginal
88148  Cytopathology smears, cervical or vaginal
88150 Cytopathology, slides, cervical or vaginal
88152 cytopathology, slides, cervical or vaginal; with manual screening and computer-assisted rescreening under physician supervision
88153 Cytopathology, slides, cervical or vaginal
88164 Cytopathology, slides, cervical or vaginal (the Bethesda System)
88165 Under Cytopathology Screening Procedures
88166 Cytopathology, slides, cervical or vaginal (the Bethesda System
88167 Cytopathology, slides, cervical or vaginal (the Bethesda System)
88174 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation
88175 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation

Question 2: 

If a client would like to account for these codes, would it appropriate to either 1) edit the measure logic to include these codes or 2) map the aforementioned codes to the valuesets/codes in the measure logic? 

Best regards, 
Varun Gregory

 Comments   
Comment by Mathematica EC eCQM Team (Inactive) [ 09/06/22 ]

We continue to investigate the issue noted in your ticket and will provide a response as soon as we are able. Thank you for your patience.

Comment by Mathematica EC eCQM Team (Inactive) [ 08/29/22 ]

Thank you for submitting your question. We will review your ticket and provide a response as soon as possible.

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