2026 MIPS Measure #420: Varicose Vein Treatment with Saphenous Ablation: Outcome Survey

Percentage of patients treated for varicose veins (CEAP C2-S) who are treated with saphenous ablation (with or without adjunctive tributary treatment) that report an improvement on a disease specific patient reported outcome survey instrument after treatment.

This measure is to be submitted after each occurrence of a fracture during the six months prior to the performance period through June 30 of the performance period. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who treat any fracture except fractures of the finger, toe, face or skull will submit this measure. Each occurrence of a fracture is identified by either an ICD-10-CM diagnosis code for fracture and a CPT service code OR an ICD-10-CM diagnosis code for a fracture and a CPT procedure code for surgical treatment of fractures.

NOTE: Patients with any fracture except fractures of the finger, toe, face or skull should have a bone mineral density (BMD) measurement performed or pharmacologic therapy prescribed. The management (BMD performed or pharmacologic therapy prescribed) should occur within 180 days of the fracture. If multiple fractures occurring on the same date of service are submitted on the same claim form, only one instance of submission will be counted. Claims data will be analyzed to determine unique occurrences. Patients already receiving pharmacologic therapy would automatically meet the intent of this measure.

NOTE: Patient encounters for this measure conducted via telehealth (including but not limited to encounters coded with GQ, GT, POS 02, POS 10) are allowable. Please note that effective January 1, 2025, while a measure may be denoted as telehealth eligible, specific denominator codes within the encounter may no longer be eligible due to changes outlined in the CY 2024 PFS Final Rule List of Medicare Telehealth Services.

Women who experienced a fracture, except fractures of the finger, toe, face or skull, during the six months prior to the performance period through June 30 of the performance period

DENOMINATOR NOTE: To assess the age for exclusions, the patient’s age on the date of the encounter should be used. *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.

OSTEOPOROSIS SCREENING & MANAGEMENT MEASURE – SUMMARY:

INCLUSION (DENOMINATOR):
- Age: 50-85 years on date of encounter
- Diagnosis: Any fracture (excluding finger, toe, face, or skull) – ICD-10-CM: M48.40XA–S92.909B (see full list)
- Encounter during performance period using eligible CPT/HCPCS codes (see full list)
- Exclude Place of Service (POS): 21 (Inpatient Hospital)

DENOMINATOR EXCLUSIONS (EXCLUDE FROM MEASURE IF ANY):
1. G9768 – Hospice services anytime during measurement period
2. G9769 – Bone mineral density test in past 2 years OR osteoporosis medication/therapy in past 12 months
3. G0048 – Palliative care services anytime during intake period through end of measurement year
4. G9938 – Age ?66 in Institutional SNP OR residing in long-term care (POS 32,33,34,54,56) for >90 consecutive days during the 6 months prior to measurement period through Dec 31
5. G2127 – Age 66-80 with frailty (claim/encounter) AND dementia medication dispensed during measurement period OR prior year
6. G2126 – Age 66-80 with frailty (claim/encounter) AND advanced illness diagnosis during measurement period OR prior year
7. G2125 – Age ?81 with frailty (claim/encounter) during the 6 months prior to measurement period through Dec 31

FRAILTY CODES (for G2127, G2126, G2125):
- HCPCS/CPT: 99504, 99509, E0100–E0171, E0250–E0304, E0424–E0472, E0561–E0562, E1130–E1298, G0162, G0299–G0300, G0493–G0494, S0271, S0311, S9123–S9124, T1000–T1031
- ICD-10-CM: L89.000–L89.96 (pressure ulcers), M62.50, M62.81, M62.84, R26.2, R26.89, R26.9, R29.6, R53.1, R53.81, R54, R62.7, R63.4, R63.6, R64, W01.0XXA–W19.XXXS (falls), Y92.199, Z59.3, Z73.6, Z74.01–Z74.9, Z91.81, Z99.11, Z99.3, Z99.81, Z99.89

ADVANCED ILLNESS CODES (for G2126):
- ICD-10-CM: A81.00–A81.09 (Prion disease), C25.0–C25.9 (Pancreatic cancer), C71.0–C71.9 (Brain cancer), C77.0–C79.9 (Metastatic cancer), C91.00–C94.32 (Leukemias), F01.50–F04 (Dementia/Alzheimer's with various complications), F10.27, F10.96–F10.97 (Alcohol-related), G10 (Huntington's), G12.21, G20.A1–G20.C (Parkinson's), G30.0–G31.83 (Alzheimer's/other degeneration), G35.A–G35.D (Multiple sclerosis), I09.81, I11.0, I12.0, I13.0–I13.2 (Hypertensive kidney disease), I50.1–I50.9 (Heart failure), J43.0–J43.9 (Emphysema), J68.4, J84.10–J84.178 (Interstitial lung disease), J96.10–J96.92 (Respiratory failure), J98.2–J98.3 (Interstitial emphysema/compensatory emphysema), K70.10–K74.69 (Liver disease/cirrhosis), N18.5–N18.6 (CKD stage 4-5)

DEMENTIA EXCLUSION MEDICATIONS (for G2127):
- Cholinesterase inhibitors: Donepezil, Galantamine, Rivastigmine
- Miscellaneous CNS agents: Memantine
- Dementia combinations: Donepezil-memantine

KEY TAKEAWAY:
Patient qualifies for measure if age 50-85 + fracture diagnosis (excluding finger/toe/face/skull) + eligible visit – EXCLUDE if any of G9768 (hospice), G9769 (prior BMD or osteoporosis meds), G0048 (palliative), G9938 (long-term care >90d), G2127 (frailty + dementia meds, age 66-80), G2126 (frailty + advanced illness, age 66-80), G2125 (frailty only, age ?81), or POS 21 (inpatient).

Patients who received either a bone mineral density test or a prescription for a drug to treat osteoporosis in the 180 days after the fracture

Pharmacologic Therapy – U.S. Food and Drug Administration approved pharmacologic options for osteoporosis prevention and/or treatment of postmenopausal osteoporosis include: bisphosphonates, alendronate, alendronate-cholecalciferol, ibandronate, risedronate, zoledronic acid, teriparatide, denosumab, abaloparatide, romosozumab and raloxifine.

Prescribed – May include prescription given to the patient for treatment of osteoporosis (as listed above) at one or more encounters during the performance period, or documentation that patient is already taking pharmacologic therapy for osteoporosis, as documented in the current medical list.

Bone Mineral Density (BMD) – A bone density test is an examination by either special x-rays or ultrasound to determine how much bone mineral content (calcium and other minerals) is present in any section of bone.

NUMERATOR NOTE: For the purposes of submitting this measure, central dual energy X-ray absorptiometry (DXA), the most common measurement for measuring bone mineral density (BMD), spinal densitometry X-ray, and peripheral dual energy Xray absorptiometry (DXA) would meet the performance and the intent of the measure. Therefore, 3095F would be submitted in the instances those screening modalities are utilized.

Performance Met: Central Dual-energy X-Ray Absorptiometry (DXA) results documented (3095F)

OR

Performance Met: Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed (G8633)

OR

Performance Not Met: Central Dual energy X-ray absorptiometry (DXA) measurement was not performed, reason not otherwise specified (3095F with 8P)

OR

Performance Not Met: Pharmacologic therapy for osteoporosis was not prescribed, reason not given (G8635)

Osteoporosis is the most common metabolic bone disease and is characterized by low bone mineral density and structural deterioration of bone tissue, causing bone fragility and increasing the risk of fractures (National Institute of Health, 2017). It is estimated that by 2020, approximately 11.9 million people age 50 and older will have osteoporosis (Wright et al., 2014). Osteoporosis affects about 25% of women age 65 and older (Looker et al., 2017).

The cost of osteoporosis-related fractures to patients, families and the health care system is $19 billion annually. Experts predict that by 2025 osteoporosis will be responsible for 3 million fractures annually, resulting in $25.3 billion in costs (National Osteoporosis Foundation, 2015). The aging U.S. population is likely to increase the financial cost of osteoporosis care.

Each year, there are approximately 1.5 million osteoporotic fractures in the United States (Black & Rosen, 2016). Fragility fractures (fractures from falls from a standing position) are considered one of the most serious warning signs of osteoporosis or low bone density. Individuals who experience a fragility fracture have a 1.5-to 9.5-fold increased risk of further fracture (Posen et al., 2013). Osteoporosis related fractures can occur in the hip, vertebrae, shin, and other bones. Hip fractures have been linked to lower quality of life, increased mortality and a dependent living status (Posen et al., 2013). A review of the Health and Retirement Study (study period between 1992 and 2010) indicated that 27% of adults age 50 and older died 1 year after a hip fracture (Cenzer et al., 2016).

Pharmacologic treatment can reduce the risk of subsequent fractures by 30%–50%. Unfortunately, testing and treatment for low bone mass after fracture has been shown to be as low as 20% (National Institute of Health, 2017). This and other research suggests a large opportunity for organizations to improve how well they manage women at an increased risk for fracture. The organization can improve its performance on this measure by both educating practitioners on follow-up care after fracture and by tracking administrative data for the occurrence of fracture and following up to ensure that appropriate care was provided.

REFERENCES:

National Institutes of Health. 2017. Osteoporosis: Overview. National Institute of Arthritis and Musculoskeletal and Skin Disorders (NIH NIAMS). https://www.bones.nih.gov/health-info/bone/osteoporosis/overview

Wright, N.C., A.C. Looker, K.G. Saag, J.R. Curtis, E.S. Delzell, S. Randall, and B. Dawson?Hughes. 2014. “The Recent Prevalence of Osteoporosis and Low Bone Mass in the United States Based on Bone Mineral Density at the Femoral Neck or Lumbar Spine.” Journal of Bone and Mineral Research 29(11), 2520–6.

Looker, A.C., N.S. Isfahani, B. Fan, and J.A. Shepherd. 2017. “Trends in Osteoporosis and Low Bone Mass in Older US Adults, 2005–2006 Through 2013–2014.” Osteoporosis International 28(6), 1979–88. National Osteoporosis Foundation. 2015. Osteoporosis Fast Facts. https://cdn.nof.org/wp-content/uploads/2015/12/Osteoporosis-Fast-Facts.pdf

Black, D.M., and C.J. Rosen. 2016. “Postmenopausal Osteoporosis.” New England Journal of Medicine 374(3), 254–62.

Posen, J., D.E. Beaton, J. Sale, and E.R. Bogoch. 2013. “Bone Mineral Density Testing After Fragility Fracture: Informative Test Results Likely.” Canadian Family Physician 59(12), E564–71.

Cenzer, I.S., V. Tang, W.J. Boscardin, A.K. Smith, C. Ritchie, M.I. Wallhagen, R. Espaldon, and K.E. Covinsky. 2016. “One?Year Mortality After Hip Fracture: Development and Validation of a Prognostic Index.” Journal of the American Geriatrics Society 64(9), 1863–8.

The U.S. Preventive Services Task Force (USPSTF) recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older (Grade B) (USPSTF 2018).

This recommendation applies to older adults without a history of low-trauma fractures and without conditions that may cause secondary osteoporosis (such as metabolic bone disease or untreated hyperthyroidism) and patients without conditions that may increase their risk of falls. This recommendation does not apply to persons who take long-term medications that may cause secondary osteoporosis (e.g., glucocorticoids, aromatase inhibitors, or gonadotropin-releasing hormone agonists). The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool (Grade B) (USPSTF 2018).

U.S. Preventive Services Task Force (USPSTF). Final Recommendation Statement - Osteoporosis to Prevent Fractures: Screening. June 2018. Accessed at: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosisscreening#fullrecommendationstart.