Measure description

Members 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 year.

Representative BP

The most recent BP reading during the measurement year 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 year, assume that the member is “not controlled”.

Important note

When identifying the most recent BP reading, all eligible BP readings in the appropriate medical record should be considered, regardless of practitioner type and setting (excluding acute inpatient and ED visit settings).


Events/diagnosis that include the member in the denominator

Two visits on different dates of service with a diagnosis of hypertension on or between January 1 of the year prior to the measurement year and June 30 of the measurement year.

  • Essential Hypertension Diagnosis Code: I10.

Visit type does not be the same for the two visits. Any of the following code combinations meet criteria:


Outpatient visit with any diagnosis of hypertension

Outpatient visit

  • 99201-99205, 99211-99215, 99241-99245, 99341-99345, 99347-99350, 99381-99387, 99391-99397, 99401-99404, 99411, 99412, 99429, 99455, 99456, 99483, G0402, G0438, G0439, G0463, T1015.

A telephone visit with any diagnosis of hypertension

Telephone visit

  • 98966, 98967, 98968.

An e-visit or virtual check-in with any diagnosis of hypertension

Online Assessment

  • 98969-98972, 994212, 99422, 99423, 99444, 99457, G0071, G2010, G2012, G2061, G2062, G2063.

Events/diagnosis that exclude the member from the denominator

  • Members receiving palliative care. For supplemental data, medical record must show documentation of member receiving palliative care.
  • Members in hospice.
  • Members with evidence of end-stage renal disease, dialysis, nephrectomy, or kidney transplant on or prior to December 31 of the measurement year.
  • Members with a diagnosis of pregnancy during the measurement year.

Supplemental and medical record data may not be used for the following exclusions.

Medicare members 66 years of age and older as of December 31 of the measurement year who meet either of the following:

  • Enrolled in an Institutional SNP any time during the measurement year.
  • Living long-term in an institution any time during the measurement year.

Members 66 years of age and older as of December 31 of the measurement year (all product lines) with frailty and advanced illness. Members must meet both of the following frailty and advanced illness criteria to be excluded:

  1. At least one claim/encounter for frailty during the measurement year.
  2. Any of the following during the measurement year or the year prior to the measurement year (count services that occur over both years):
    • At least two of the following: outpatient visits; observation visits; ED visits; telephone visits; e-visits or virtual check-ins; non-acute inpatient encounters or non-acute inpatient discharges on different dates of service, with an advanced illness diagnosis. Visit type need not be the same for the two visits.
    • At least one acute inpatient encounter with an advanced illness diagnosis.
    • At least one acute inpatient discharge with an advanced illness diagnosis on the discharge claim.
    • A dispensed dementia medication:
      • Donepezil.
      • Donepezil-memantine.
      • Galantamine.
      • Memantine.
      • Rivastigimine.
    • Members 81 year of age and older as of December 31 of the measurement year with frailty during the measurement year.

CPT Codes for allowable visits

Outpatient visit

  • 99201-99205, 99211-99215, 99241-99245, 99341-99345, 99347-99350, 99381-99387, 99391-99397, 99401-99404, 99411, 99412, 99429, 99455, 99456, 99483, G0402, G0438, G0439, G0463, T1015.

Remote blood pressure monitoring

  • 93784, 93788, 93790, 99091, 99453, 99454, 99457, 99473, 99474.

Telephone visit

  • 98966, 98967, 98968.

Online assessment

  • 98969-98972, 994212, 99422, 99423, 99444, 99457, G0071, G2010, G2012, G2061, G2062, G2063.

Non-acute inpatient

  • 99304-99310, 99315, 99316, 99318, 99324-99328, 99334-99337.

CPT II codes for blood pressure readings

Systolic

  • 3074F, 3075F, 3077F.

Diastolic

  • 3078F, 3079F, 3080F.

Notes specific to this measure

  • Do not include BP readings that are taken on the same day as a diagnostic test or diagnostic or therapeutic procedure that requires a change in diet or a change in medication on or one day before the test or procedure, with the exception of fasting blood tests.
  • Do not include BP readings that are taken by the member using a non-digital device such as with a manual blood pressure cuff and a stethoscope.
  • The gap is closed if the blood pressure reading is <140/90 mm Hg. The gap is not closed if the blood pressure reading is < 140/90 mm Hg, if there is no reading during the measurement year, or if the reading is incomplete (systolic or diastolic level missing). If there are multiple readings on the same date of service, use the lowest systolic and lowest diastolic reading on that date as the representative reading.

Controling blood pressure - Diabetes care

Measure description

Members 18–75 years of age with Type 1 or Type 2 diabetes whose most recent blood pressure taken during an outpatient visit, telephone visit, e-visit or virtual check-in, or a nonacute inpatient encounter during the measurement year is < 140/90 mm Hg. If multiple readings are recorded in a single date, use the lowest systolic and lowest diastolic BP on that date. The systolic and diastolic results do not need to be from the same reading.

CPT codes for allowable visits:

Outpatient visit

  • 99201-99205, 99211-99215, 99241-99245, 99341-99345, 99347-99350, 99381-99387, 99391-99397, 99401-99404, 99411, 99412, 99429, 99455, 99456, 99483, G0402, G0438, G0439, G0463, T1015.

Remote blood pressure monitoring

  • 93784, 93788, 93790, 99091, 99453, 99454, 99457, 99473, 99474.

Telephone visit

  • 98966, 98967, 98968.

Online assessment

  • 98969-98972, 994212, 99422, 99423, 99444, 99457, G0071, G2010, G2012, G2061, G2062, G2063.

Non-acute inpatient

  • 99304-99310, 99315, 99316, 99318, 99324-99328, 99334-99337.

CPT II codes for blood pressure readings:

Systolic

  • 3074F, 3075F, 3077F.

Diastolic

  • 3078F, 3079F, 3080F.

Notes specific to this sub measure

Do not include BP readings taken on the same day as a diagnostic test or diagnostic or therapeutic procedure that requires a change in diet or a change in medication on or one day before the test or procedure, with the exception of fasting blood tests.

Do not include BP readings that are taken by the member using a non-digital device such as with a manual blood pressure cuff and a stethoscope.