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Breast Cancer Screening (BCS)

Based on current NCQA HEDIS recommendations, your TO-DO LIST for women between 50 and 74 years of age should include:

  • A screening mammogram at least once every 2 years

Why should you complete your TO-DO LIST?

It is an evidence-based, best practice and these actions are used to measure your quality performance.

HEDIS Breast Cancer Screening (BCS) Definition:

(NCQA HEDIS guidelines, Measurement Year (MY) 2022)

  • The percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
  • Line of Business: Commercial, Medicaid, Medicare

Requirement:

One or more mammograms (Mammography Value Set) any time on or between October1 two years prior to the measurement year and December31 of the measurement year

How does your completion of the TO-DO LIST get recorded?

Codes Related to Breast Cancer Screening

Mammography

CPT 77061 77062 77063 77065 77066 77067

HCPCS G0202 G0204 G0206

LOINC 24604-1 24605-8 24606-6 24610-8 26175-0 26176-8 26177-6 26287-3 26289-9 26291-5 26346-7 26347-5 26348-3 26349-1 26350-9 26351-7 36319-2 36625-2 36626-0 36627-8 36642-7 36962-9 37005-6 37006-4 37016-3 37017-1 37028-8 37029-6 37030-4 37037-9 37038-7 37052-8 37053-6 37539-4 37542-8 37543-6 37551-9 37552-7 37553-5 37554-3 37768-9 37769-7 37770-5 37771-3 37772-1 37773-9 37774-7 37775-4 38070-9 38071-7 38072-5 38090-7 38091-5 38807-4 38820-7 38854-6 38855-3 42415-0 42416-8 46335-6 46336-4 46337-2 46338-0 46339-8 46350-5 46351-3 46356-2 46380-2 48475-8 48492-3 69150-1 69251-7 69259-0

SNOMED CT US Edition 12389009 24623002 43204002 71651007 241055006 241057003 241058008 258172002 439324009 450566007 709657006 723778004 723779007 723780005 726551006 833310007 866234000 866235004 866236003 866237007 384151000119104 392521000119107 392531000119105 566571000119105 572701000119102

Supplemental Data Requirements

  1. A mammography report from the appropriate timeframe can be submitted as supplemental data for gap closure.
  2. A signed and dated progress note that lists the date of the mammogram may also be submitted for gap closure.
  3. A signed and dated progress note with documentation of exclusion (date of bilateral mastectomy or dates of two unilateral mastectomies) can be submitted as supplemental data for gap closure.

Note: Biopsies, breast ultrasounds or MRIs do not meet compliance for this measure because they are not appropriate methods for primary breast cancer screening.

General Notes

The most accurate method to submit data for clinical quality gap closure is through correct coding. Supplemental data submission can be used for gap closure when information is not received through coding. All supplemental data must be signed and dated by a treating physician, nurse practitioner or physician assistant. All dates must include month, day and year.

Patient name and birthdate needs to be on all supplemental documentation. If birthdate is not officially on a report, it needs to be either written on the document and signed by the physician, or a demographic cover sheet should be included as an additional page with the submission.

Resources available for you and your patients:

The American Congress of Obstetricians and Gynecologists (ACOG)

American College of Radiology

American Cancer Society

U.S Preventive Services Task Force

To learn more about your practice’s current HEDIS performance for this or other measures, or for assistance in compliance with the HEDIS guidelines, please contact Horizon Healthy Journey: 1-844-754-2451.

Reference: NCQA HEDIS Measurement Year (MY) 2022 Technical Specs CPT® is a registered trademark of the American Medical Association.