Product Lines:
Advantage MD, Dual Eligible Special Needs Plans (D-SNP), EHP, Priority Partners, and USFHP.

Measurement Period: January 1 - December 31

Description:
The percentage of persons 18–85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90 mm Hg) during the measurement period.

Stratifications: Report stratification by race and ethnicity

Measure Reporting: 
CMS Start Rating Measure.  
HealthChoice Performance Measure reporting for Priority Partners.  

Improvement Notation:
Increased score indicates improvement.

Data Collection:

• Administrative.
  
• Hybrid.
  
• Supplemental.
  

Initial Population:

• Measure Item Count: Person.
  
• Age: 18–85 years of age as of the last day of the measurement period.
  
• Benefits: Medical.
  
• Continuous Enrollment: The measurement period.
  
• Allowable Gap: No more than one gap of ≤45 days during the measurement period. No gaps on the last day of the measurement period.
  

Definition:
Adequate control: Both a representative systolic BP <140 mm Hg and a representative diastolic BP of <90 mm Hg.

Representative BP: The most recent BP reading during the measurement period on or after the second diagnosis of hypertension. If multiple BP measurements occur on the same date, or are noted in the chart on the same date, use the lowest systolic and lowest diastolic BP reading. If no BP is recorded during the measurement period, assume the BP is “not controlled.”

Denominator:
Persons with a diagnosis of hypertension.  
Persons who had at least two outpatient visits, telephone visits, e-visits or virtual check-ins on different dates of service with a diagnosis of hypertension on or between January 1 of the year prior to the measurement period and June 30 of the measurement period.

Numerator:
Both a systolic and diastolic reading <140/90 mm Hg. 
The most recent BP reading taken during the measurement period. 

• Compliant: BP is <140/90 mm Hg.
  
• Non-compliant: BP is ≥140/90 mm Hg; no BP reading during the measurement period; or if the reading is incomplete (e.g., the systolic or diastolic level is missing).
  

If there are multiple BPs on the same date of service, use the lowest systolic and lowest diastolic BP on that date as the representative BP. 

Best Practice and Measure Tips

• Allow person to rest for at least 5 minutes before taking the BP. Select appropriately sized BP cuff, and place cuff on bare arm.
• Ensure person is seated with feet on the floor, back supported and arm supported at heart level.
• If office uses manual blood pressure cuffs, do not round up the BP reading.
• If initial BP is > 140/90, retake the person's BP after they’ve had time to rest. If remains elevated, ensure member follows up for BP check.
  • Since the last BP in the year is used, have person follow up for elevated BPs prior to the end of the year or follow Guidelines for Person Reported BP Readings if a visit is not possible
• Establish and maintain standardized protocols to ensure staff consistently obtain accurate blood pressure measurements. Refer to the American Medical Association (AMA) Control High BP best practices for evidence‑based recommendations and opportunities for quality improvement. 
• Educate the person on the importance of blood pressure management, and offer supportive resources such as an informational flyer and a blood pressure tracking log. 
  
  • AMA Self-measured blood pressure (SMBP) quick guide
  • AMA Self-measured blood pressure log
• BP reading taken during an Urgent Care visit is acceptable.

Multiple BPs on same date of service:

• It is preferred to not average BP since the lowest systolic and lowest diastolic are to be used.
• If the only BP is an average BP, if it is documented “average BP today: 139/70” it is eligible for use.

Guidelines for Person Reported BP Readings Documented in the Medical Record:

• The documentation must include the date the blood pressure was taken.
• Only readings obtained with a digital device are acceptable for person reported BP. If the documentation does not specify the device type, it may be assumed to be digital.
• BP readings may be collected during telephone visits, e visits, or virtual check ins. Persons should take their BP before the visit and report the reading during the encounter.
• Person reported BP readings submitted through MyChart or other patient portals must include the date the BP was taken.
• Persons who bring their BP readings to an in person visit may have those readings used only if the date the BP was taken is documented. If the date is missing, the reading cannot be used. This requirement applies specifically to in person visits. 

BP readings taken the same day person receives a common low-intensity or preventive procedure can be used. Examples include, but aren’t limited to:

• Eye exam with dilating agents
• Injections (e.g., allergy, Depo Provera,® insulin, lidocaine, steroid, testosterone toradol, or vitamin B-12),
• Intrauterine device (IUD) insertion.
• Tuberculosis (TB) test
• Vaccinations.
• Wart or mole removal
• Fasting Blood Tests

Do not include BP readings:

• Taken during an acute inpatient stay or an ED visits.
• Taken on the same day as a diagnostic test or procedure that requires a medication regimen, change in diet or medication on or one day before the day of the test or procedure, with the exception of fasting blood tests. 
  • Examples include, but are not limited to: Colonoscopy, Dialysis, Infusions, Chemotherapy, Nebulizer treatment with albuterol
• Person taken manual BPs reported are not acceptable at this time.
• Documented as a range or threshold.
• An incomplete BP reading (systolic or diastolic only).
• An aortic systolic/diastolic noninvasive central blood pressure measurement.

Measure Exclusions

Denominator Exclusions:

• Persons receiving palliative care
• Persons in hospice or using hospice services any time during the measurement period.
• Persons 66–80 years of age by the last day of the measurement period, with both frailty and advanced illness. 
• Persons 81 years of age and older as of the last day of the measurement period, with frailty. 
• Persons who died any time during the measurement year.
• Persons with any of the following during their history on or prior to the last day of the measurement period: 
  • Diagnosis that indicates end-stage renal disease (ESRD) (ESRD Diagnosis Value Set; History of Nephrectomy or Kidney Transplant Value Set).
  • Procedure that indicates ESRD: dialysis (Dialysis Procedure Value Set), nephrectomy (Total Nephrectomy Value Set; Partial Nephrectomy Value Set) or kidney transplant (Kidney Transplant Value Set). 
• Acute inpatient and ED visit during measurement year.
• Persons with a diagnosis of pregnancy
• Non-acute inpatient admission during measurement year.
  • This includes rehabilitation, nursing home, inpatient mental health, etc.
• Medicare enrollees, 66 years of age and older by the last day of the measurement period, in an institutional SNP (I-SNP) or living long-term in an institution (LTI). 
• Laboratory claims (claims with POS code 81).

Exclusion Codes:

• ESRD Diagnosis
  • ICD-10-CM: N18.5, N18.6
  • SNOMED CT US Edition: 46177005, 236434000, 236435004, 236436003, 433146000, 698810000, 704667004, 707324008, 712487000, 714152005, 714153000, 1332467008, 711000119100, 90761000119106, 90771000119100, 90791000119104, 96711000119105, 111411000119103, 120261000119101, 127991000119101, 128001000119105, 129161000119100, 140101000119109, 153851000119106, 153891000119101, 285011000119108, 285841000119104, 286371000119107, 368461000119103, 368471000119109, 434431000124103 
• History of Kidney
  • ICD-10-CM: Z90.5, Z94.0
  • SNOMED CT US Edition: 48994000. 161665007 
• Dialysis Procedure
  • CPT: 90935, 90937, 90945, 90947, 90997, 90999, 99512 
  • HCPCS: G0257, S9339
  • ICD-10-PCS: 3E1M39Z, 5A1D00Z, 5A1D60Z, 5A1D70Z, 5A1D80Z, 5A1D90Z
• Total Nephrectomy
  • CPT: 50220, 50225, 50230, 50234, 50236, 50340, 50370, 50543, 50545, 50546, 50548 
  • ICD-10-PCS: 0TT00Z0, 0TT00Z1, 0TT00Z2, 0TT00ZZ, 0TT04ZG, 0TT04ZZ, 0TT10Z0, 0TT10Z1, 0TT10Z2, 0TT10ZZ, 0TT14ZG, 0TT14ZZ, 0TT20ZZ, 0TT24ZG, 0TT24ZZ 
  • SNOMED CT US Edition:1866009, 12976005, 48643009, 48994000, 58367002, 85250002, 88930008, 88994001, 116033007, 116166009, 149579003, 149583003, 149584009, 175905003, 175906002, 175909009, 175910004, 175911000, 175914008, 175915009, 265550007, 284348003, 287729007, 289754003, 290691008, 361249003, 439235001, 439964001, 440446009, 442919002, 443869003, 444083005, 446296004, 446990000, 447527008, 447531002, 698869007, 699719001, 699720007, 708908003, 712998006, 714031000, 722149000, 765472003, 765473008, 1017216005, 1017217001, 1017218006, 1017219003, 1289993008, 6561000179108 
• Partial Nephrectomy
  • CPT: 50240
  • ICD-10-PCS: 0TB00ZZ, 0TB03ZZ, 0TB04ZZ, 0TB07ZZ, 0TB08ZZ, 0TB10ZZ, 0TB13ZZ, 0TB14ZZ, 0TB17ZZ, 0TB18ZZ
  • SNOMED CT US Edition: 48994000, 49780003, 51870000, 58367002, 81516001, 85250002, 88994001, 149579003, 149581001, 149584009, 175908001, 175909009, 175910004, 175916005, 175917001, 175918006, 175919003, 175920009, 236140002, 287729007, 289754003, 290691008, 439739008, 446894005, 699719001, 699720007, 708929007, 1119317007, 1119318002, 1119319005, 1119320004 
• Kidney Transplant
  • CPT: 50360, 50365, 50380
  • HCPCS: S2065
  • ICD-10-PCS: 0TY00Z0, 0TY00Z1, 0TY00Z2, 0TY10Z0, 0TY10Z1, 0TY10Z2
  • SNOMED CT US Edition: 52213001, 70536003, 175899003, 175901007, 175902000, 236138007, 313030004, 711411006, 711413009, 765478004, 765479007, 782655004, 6471000179103 
• Nonacute Inpatient Stay
  • UBREV: 0022, 0024, 0118, 0128, 0138, 0148, 0158, 0190, 0191, 0192, 0193, 0194, 0199, 0524, 0525, 0550, 0551, 0552, 0559, 0660, 0661, 0662, 0663, 0669, 1000, 1001, 1002
  • UBTOB: 0180, 0181, 0182, 0183, 0184, 0185, 0187, 0188, 0210, 0211, 0212, 0213, 0214, 0215, 0217, 0218, 0220, 0221, 0222, 0223, 0224, 0225, 0227, 0228, 0280, 0281, 0282, 0283, 0284, 0285, 0287, 0288, 0289, 0650, 0651, 0652, 0653, 0654, 0655, 0657, 0658, 0660, 0661, 0662, 0663, 0664, 0665, 0667, 0668, 0860, 0861, 0862, 0863, 0864, 0865, 0867, 0868, 018F, 018G, 018H, 018I, 018J, 018K, 018M, 018O, 018X, 018Y, 018Z, 021F, 021G, 021H, 021I, 021J, 021K, 021M, 021O, 021X, 021Y, 021Z, 022F, 022G, 022H, 022I, 022J, 022K, 022M, 022O, 022X, 022Y, 022Z, 028F, 028G, 028H, 028I, 028J, 028K, 028M, 028O, 028X, 028Y, 028Z, 065F, 065G, 065H, 065I, 065J, 065K, 065M, 065O, 065X, 065Y, 065Z, 066F, 066G, 066H, 066I, 066J, 066K, 066M, 066O, 066X, 066Y, 066Z, 086F, 086G, 086H, 086I, 086J, 086K, 086M, 086O, 086X, 086Y, 086Z 

Measure Codes

Essential Hypertension 

• ICD-10-CM: I10

Systolic Blood Pressure

• Systolic Less Than 140 CPT-CAT-II: 3074F (<130 mm Hg), 3075F (130-139 mm Hg)
• Systolic Greater Than or Equal to 140 CPT-CAT-II: 3077F
• LOINC: 8459-0, 8480-6, 8508-4, 8546-4, 8547-2, 75997-7

Diastolic Blood Pressure

• Diastolic Less Than 90 CPT-CAT-II:  3078F (<80 mm Hg), 3079F (80-89 mm Hg)
• Diastolic Greater Than or Equal to 90 CPT-CAT-II:  3080F
• LOINC: 8453-3, 8462-4, 8496-2, 8514-2, 8515-9, 75995-1