Product Lines:
Advantage MD.

Measurement Period: January 1 - December 31

Description:
The percentage of women 65–75 years of age who received osteoporosis screening.

Improvement Notation:
Increased score indicates improvement.

Data Collection:

• Administrative.
• Supplemental.

Initial Population:

• Measure Item Count: Person.
• Age: 66–75 years of age as of the last day of the measurement period.
• Gender/sex criteria: Administrative Gender of Female any time in the person’s history.
• Benefits: Medical and Pharmacy.
• Continuous Enrollment: The measurement period and the year prior to the measurement period.
• Allowable Gap: No more than one gap of ≤45 days during each year of the continuous enrollment period. No gaps on the last day of the measurement period.

Denominator:
The initial population minus denominator exclusions.

Numerator:
One or more osteoporosis screening tests on or between the person’s 65th birthday and the last day of the measurement period

Summary of changes:
Added an administrative gender code to the initial population.

Best Practice and Measure Tips

• Ensure members without a diagnosis and who have not been treated for osteoporosis receive bone mineral testing.
• Educate member about bone health and adopting healthy practices:
  • Maintain a balance diet
  • Engage in weight-bearing exercises
  • Adequate Calcium and Vitamin D Intake
  • Preventing and avoiding falls
  • Review medications that may cause bone loss
  • Review diseases, conditions and medical procedures that may cause bone loss
  • Avoiding smoking and limiting alcohol.

Measure Exclusions

Denominator Exclusions:

• Persons in hospice or using hospice services any time during the measurement period.
• Persons who died any time during the measurement period.
• Persons receiving Palliative Care or had an encounter for Palliative Care any time during the intake period through the last day of the measurement period.
• Persons 66 years of age or older by the last day of the measurement period, with both frailty and advanced illness.
• 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).
• Persons who had a dispensed prescription to treat osteoporosis (Osteoporosis Medications List) any time on or between January 1 three years prior to the measurement period through the last day of the year prior to the measurement period.
• Persons who had a claim/encounter for osteoporosis therapy (Osteoporosis Medication Therapy; Long-Acting Osteoporosis Medications) any time in the person's history through the last day of the year prior to the measurement period.

Exclusion Codes

Osteoporosis Medication Therapy

• HCPCS: J0897, J1740, J3110, J3111, J3489, Q5136, Q5157, Q5158, Q5159

Long-Acting Osteoporosis Medications          

• HCPCS: J0897, J1740, J3489, Q5136, Q5157, Q5158, Q5159

Exclusion Medications

Osteoporosis Medications

• Abaloparatide
• Alendronate
• Alendronate-cholecalciferol
• Denosumab
• Ibandronate
• Raloxifene
• Risedronate
• Romosozumab
• Teriparatide
• Zoledronic acid

Measure Codes

DXA Bone Density Tests

• LOINC: 101804-3, 101805-0, 104938-6, 24701-5, 24890-6, 24966-4, 38261-4, 38262-2, 38263-0, 38264-8, 38265-5, 38266-3, 38267-1, 46278-8, 46279-6, 46383-6, 80932-7, 80933-5, 80934-3, 80935-0, 80936-8, 80937-6, 80938-4, 80939-2, 80940-0, 80941-8, 80942-6, 80943-4, 80944-2, 80945-9, 80946-7, 80947-5, 80948-3, 80949-1, 80950-9, 80951-7, 80952-5, 80953-3, 80954-1, 80955-8, 80956-6, 85385-3, 85386-1, 85387-9, 85388-7, 85389-5, 85390-3, 85391-1, 85392-9, 85393-7, 85394-5

Osteoporosis Screening Test Diagnostic Reports

• LOINC: 100225-2, 38268-9, 38269-7, 83012-5, 83013-3, 83014-1, 83051-3

Osteoporosis Screening Tests Procedures

• CPT: 76977, 77080, 77081, 77085