Product Lines:
Advantage MD.

Eligible Population:
Women 66-75 years of age as of December 31 of the measurement year.

Definition:
The percentage of women 65–75 years of age who received osteoporosis screening tests on or between the member’s 65th birthday and December 31 of the measurement year.

Continuous Enrollment:

• The measurement year and the year prior to the measurement year.

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

Required Exclusions:

• Members in hospice or using hospice services anytime during the measurement year.
• Members who died any time during the measurement year
• Palliative Care
• Frailty and Advanced Illness 
• Living in Long Term Care
• Members who had a dispensed prescription to treat osteoporosis (Osteoporosis Medications List) any time on or between January 1 three years prior to the measurement year through December 31 of the year prior to the measurement year.
• Members who had a claim/encounter for osteoporosis therapy (Osteoporosis Medication Therapy; Long-Acting Osteoporosis Medications) any time in the member’s history through December 31 of the year prior to the measurement year.

Osteoporosis Medications

Exclusion Codes

• Osteoporosis Medication Therapy Value Set
  • HCPCS: J0897, J1740, J3110, J3111, J3489
• Long-Acting Osteoporosis Medications Value Set
  • HCPCS: J0897, J1740, J3489

Measure Codes

• Osteoporosis Screening Tests 
  • CPT: 76977, 77078, 77080, 77081, 77085