Children Who Have Dental Decay or Cavities

Compare Versions of: "Children Who Have Dental Decay or Cavities"

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Measure Information	2022 Performance Period	2023 Performance Period	2024 Performance Period	2025 Performance Period
Title	Children Who Have Dental Decay or Cavities	Children Who Have Dental Decay or Cavities	Children Who Have Dental Decay or Cavities	Children Who Have Dental Decay or Cavities
CMS eCQM ID	CMS75v10	CMS75v11	CMS75v12	CMS75v13
CBE ID*	Not Applicable	Not Applicable	Not Applicable	Not Applicable
MIPS Quality ID	378	378	378	378
Measure Steward	Centers for Medicare & Medicaid Services (CMS)	Centers for Medicare & Medicaid Services (CMS)	Centers for Medicare & Medicaid Services (CMS)	Centers for Medicare & Medicaid Services (CMS)
Description	Percentage of children, 6 months - 20 years of age at the start of the measurement period, who have had tooth decay or cavities during the measurement period	Percentage of children, 6 months - 20 years of age at the start of the measurement period, who have had tooth decay or cavities during the measurement period as determined by a dentist	Percentage of children, 1 - 20 years of age at the start of the measurement period, who have had tooth decay or cavities during the measurement period as determined by a dentist	Percentage of children, 1-20 years of age at the start of the measurement period, who have had dental decay or cavities during the measurement period as determined by a dentist
Measure Scoring	Proportion measure	Proportion measure	Proportion measure	Proportion measure
Measure Type	Outcome	Outcome	Outcome	Outcome
Stratification	*See CMS75v10.html	*See CMS75v11.html	None	None
Risk Adjustment	*See CMS75v10.html	*See CMS75v11.html	None	None
Rationale	*See CMS75v10.html	*See CMS75v11.html	Dental caries is the most chronic disease among youth aged 6-19 years. Data from the National Health and Nutrition Examination Survey from 2015-2016 showed that approximately 45.8% of children and youth aged 2-19 years had total caries (untreated and treated). Prevalence of total dental caries (untreated and treated) in primary or permanent teeth increases with age, going from 21.4%, 50.5%, and 53.8% among ages 2-5, 6-11, and 12-19, respectively. Total dental caries was highest in Hispanic youths aged 2-19 at 57.1% compared to 48.1% for non-Hispanic black, 44.6% for non-Asian, and 40.4% for non-Hispanic white youth. Monitoring prevalence of untreated and total caries is vital to preventing and controlling oral disease (Fleming & Afful, 2018). Children who have dental decay or cavities are less likely to be in very good or excellent overall health than children without decay or cavities (Edelstein & Chinn, 2009). Children with decay are also more likely to have other oral health problems such as toothaches, broken teeth, and bleeding gums (Data Resource Center for Child and Adolescent Health, 2007).	Dental caries is the most chronic disease among youth aged 6-19 years. Data from the National Health and Nutrition Examination Survey from 2015-2016 showed that approximately 45.8 percent of children and youth aged 2-19 years had total caries (untreated and treated). Prevalence of total dental caries (untreated and treated) in primary or permanent teeth increases with age, going from 21.4 percent, 50.5 percent, and 53.8 percent among ages 2-5, 6-11, and 12-19, respectively. Total dental caries was highest in Hispanic youths aged 2-19 at 57.1 percent compared to 48.1 percent for non-Hispanic black, 44.6 percent for non-Asian, and 40.4 percent for non-Hispanic white youth. Monitoring prevalence of untreated and total caries is vital to preventing and controlling oral disease (Fleming & Afful, 2018). Children who have dental decay or cavities are less likely to be in very good or excellent overall health than children without decay or cavities (Edelstein & Chinn, 2009). Children with decay are also more likely to have other oral health problems such as toothaches, broken teeth, and bleeding gums (Data Resource Center for Child and Adolescent Health, 2007).
Clinical Recommendation Statement	*See CMS75v10.html	*See CMS75v11.html	This is an outcome measure. As such, no clinical recommendations are included.	The American Academy of Pediatric Dentistry (AAPD) provides clinical recommendations for pediatric oral health assessments and preventative services (AAPD, 2023). The recommendation states that the first clinical oral examination should occur around 12 months of age. The clinical oral exam should be repeated every 6 months or as indicated by the child’s risk status or susceptibility to disease. Further, caries risk assessment must be repeated regularly and frequently to maximize effectiveness.
Improvement Notation	A lower score indicates better quality	A lower score indicates better quality	A lower score indicates better quality	A lower score indicates better quality
Definition	*See CMS75v10.html	*See CMS75v11.html	None	None
Guidance	This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible codes and requires a clinical action that cannot be conducted via telehealth. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.	This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible codes and requires a clinical action that cannot be conducted via telehealth. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.	This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible codes and requires a clinical action that cannot be conducted via telehealth. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.	This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible codes and requires a clinical action that cannot be conducted via telehealth. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.
Initial Population	Children, 6 months - 20 years of age, with a clinical oral evaluation during the measurement period	Children, 6 months - 20 years of age at the start of the measurement period, with a clinical oral evaluation by a dentist during the measurement period	Children, 1 - 20 years of age at the start of the measurement period, with a clinical oral evaluation by a dentist during the measurement period	Children, 1-20 years of age at the start of the measurement period, with a clinical oral evaluation by a dentist during the measurement period
Denominator	Equals Initial Population	Equals Initial Population	Equals Initial Population	Equals Initial Population
Denominator Exclusions	Exclude patients who are in hospice care for any part of the measurement period.	Exclude patients who are in hospice care for any part of the measurement period	Exclude patients who are in hospice care for any part of the measurement period	Exclude patients who are in hospice care for any part of the measurement period
Numerator	Children who had a diagnosis of cavities or decayed teeth in any part of the measurement period	Children who had a diagnosis of cavities or decayed teeth in any part of the measurement period	Children who had a diagnosis of cavities or decayed teeth in any part of the measurement period	Children who had a diagnosis of cavities or decayed teeth in any part of the measurement period
Numerator Exclusions	Not applicable	Not Applicable	Not Applicable	Not Applicable
Denominator Exceptions	None	None	None	None
Telehealth Eligible	No	No	No	No
Next Version	CMS75v11	CMS75v12	CMS75v13	No Version Available
Previous Version	No Version Available	CMS75v10	CMS75v11	CMS75v12

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Specifications

Additional Resources for CMS75v12

CMS75v12-TRN.xlsx

Header

Revised the age range from 6 months-20 years old to 1-20 years old to align with existing dental measures, such as those in the Medicaid Child Core set.
Measure Section: Description
Source of Change: Measure Lead
Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
Revised the age range from 6 months-20 years old to 1-20 years old to align with existing dental measures, such as those in the Medicaid Child Core set.
Measure Section: Initial Population
Source of Change: Measure Lead

Logic

Revised the age range from 6 months-20 years old to 1-20 years old to align with existing dental measures, such as those in the Medicaid Child Core set.
Measure Section: Initial Population
Source of Change: Measure Lead
Added 'day of' specificity to hospice expressions for consistency.
Measure Section: Definitions
Source of Change: Measure Lead
Added QDM datatype 'Diagnosis' to the Hospice.'Has Hospice Services' definition referencing a new value set containing SNOMED finding codes to provide an additional approach for identifying patients receiving hospice care.
Measure Section: Definitions
Source of Change: Measure Lead
Updated the version number of the Hospice Library to v5.0.000.
Measure Section: Definitions
Source of Change: Annual Update
Updated the version number of the Hospice Library to v5.0.000.
Measure Section: Functions
Source of Change: Annual Update

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

Value set Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584): Deleted 3 SNOMED CT codes (170935008, 170936009, 305911006) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Hospice Diagnosis (2.16.840.1.113883.3.464.1003.1165) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Hospice Encounter (2.16.840.1.113883.3.464.1003.1003): Added 2 SNOMED CT codes (305911006, 385765002) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Payer (2.16.840.1.114222.4.11.3591): Added 5 SOP codes (1111, 1112, 142, 344, 141) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead