Oncology: Medical and Radiation - Pain Intensity Quantified
Compare Versions of: "Oncology: Medical and Radiation - Pain Intensity Quantified"
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| Measure Information | 2024 Performance Period | 2025 Performance Period | 2026 Performance Period | 2027 Performance Period |
|---|---|---|---|---|
| Title | Oncology: Medical and Radiation - Pain Intensity Quantified | Oncology: Medical and Radiation - Pain Intensity Quantified | Oncology: Medical and Radiation - Pain Intensity Quantified | Oncology: Medical and Radiation - Pain Intensity Quantified |
| CMS eCQM ID | CMS157v12 | CMS157v13 | CMS157v14 | CMS157v15 |
| CBE ID* | 0384e | 0384e | 0384e | 0384e |
| MIPS Quality ID | 143 | 143 | 143 | 143 |
| Measure Steward | American Society of Clinical Oncology | American Society of Clinical Oncology | American Society of Clinical Oncology | American Society of Clinical Oncology |
| Description |
Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified |
Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified |
Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified |
Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified |
| Measure Scoring | Proportion | Proportion | Proportion | Proportion |
| Measure Type | Process | Process | Process | Process |
| Stratification |
None |
None |
None |
None |
| Risk Adjustment |
None |
None |
None |
None |
| Rationale |
An estimated 1,806,590 new cases of cancer were projected to be diagnosed in the US in 2020 (NIH, 2020). Pain is a commonly occurring symptom for cancer patients as 30% to 50% (510,000 to 850,000 each year based on current statistics) will experience moderate to severe pain (Wiffen, Wee, Derry, Bell, & Moore, 2017). Initial and ongoing pain assessments are essential to determine the pathophysiology of pain and ensure proper pain management. According to the National Comprehensive Cancer Network (NCCN, 2022), undertreatment of pain remains a problem among a significant subset of cancer patients, survival is linked with symptom control and pain management, and pain management contributes to broad quality of life improvement. Furthermore, NCCN notes that formal pain reevaluation is required at each contact to ensure fulfilment of patient goals around comfort, function, and safety. Cancer patients have reported that pain interferes with their mood, work, relationships with other people, sleep and overall enjoyment of life (Moryl et al., 2018). To maximize patient outcomes, pain management is an essential part of oncologic management (NCCN, 2022). A recent analysis of registry data for chronic pain cancer patients found average pain intensity reported as mild (24.6% of patients), moderate (41.5%), and severe (33.9%). The study also indicated that patient report of pain relief is inversely related to the average pain intensity reported (Moryl et al., 2018). These data suggest that assessing and managing a cancer patient’s pain is critical and there remains significant room for improvement in assessing and mitigating cancer-related pain. A prospective study of changes in pain severity of cancer patients found that, at initial assessment, 47% of patients reported pain. At follow-up, the patients with pain at initial assessment reported reduced pain (32.2%), stable pain (48.2%) and worse pain (19.6%). Of the 53% of patients reporting no pain at initial assessment, 82.6% reported stable pain and 17.4% reported worse pain at follow-up assessment (Zhao et al., 2014). This study highlights the importance of initial and ongoing assessments of pain to identify gaps and ensure proper pain management. |
Pain is a commonly occurring symptom for cancer patients as 30% to 50% (510,000 to 850,000 each year based on current statistics) will experience moderate to severe pain (Wiffen, Wee, Derry, Bell, & Moore, 2017). Initial and ongoing pain assessments are essential to determine the pathophysiology of pain and ensure proper pain management. According to the National Comprehensive Cancer Network (NCCN, 2023), undertreatment of pain remains a problem among a significant subset of cancer patients, survival is linked with symptom control and pain management, and pain management contributes to broad quality of life improvement. Furthermore, NCCN notes that formal pain reevaluation is required at each contact to ensure fulfilment of patient goals around comfort, function, and safety. Cancer patients have reported that pain interferes with their mood, work, relationships with other people, sleep and overall enjoyment of life (Moryl et al., 2018). To maximize patient outcomes, pain management is an essential part of oncologic management (NCCN, 2023). A recent analysis of registry data for chronic pain cancer patients found average pain intensity reported as mild (24.6% of patients), moderate (41.5%), and severe (33.9%). The study also indicated that patient report of pain relief is inversely related to the average pain intensity reported (Moryl et al., 2018). These data suggest that assessing and managing a cancer patient’s pain is critical and there remains significant room for improvement in assessing and mitigating cancer-related pain. A prospective study of changes in pain severity of cancer patients found that, at initial assessment, 47% of patients reported pain. At follow-up, the patients with pain at initial assessment reported reduced pain (32.2%), stable pain (48.2%) and worse pain (19.6%). Of the 53% of patients reporting no pain at initial assessment, 82.6% reported stable pain and 17.4% reported worse pain at follow-up assessment (Zhao et al., 2014). This study highlights the importance of initial and ongoing assessments of pain to identify gaps and ensure proper pain management. |
Pain is a commonly occurring symptom for cancer patients as 30% to 50% (510,000 to 850,000 each year based on current statistics) will experience moderate to severe pain (Wiffen, Wee, Derry, Bell, & Moore, 2017). Initial and ongoing pain assessments are essential to determine the pathophysiology of pain and ensure proper pain management. According to the National Comprehensive Cancer Network (NCCN, 2024), undertreatment of pain remains a problem among a significant subset of cancer patients, survival is linked with symptom control and pain management, and pain management contributes to broad quality of life improvement. Furthermore, NCCN notes that formal pain reevaluation is required at each contact to ensure that pain management therapies are successfully meeting patient-specific goals for comfort, function, and safety. Cancer patients have reported that pain interferes with their mood, work, relationships with other people, sleep and overall enjoyment of life (Moryl et al., 2018). Pain management is an essential part of oncologic management and contributes to a patient’s overall function and quality of life (NCCN, 2024). A recent analysis of registry data for chronic pain cancer patients found average pain intensity reported as mild (24.6% of patients), moderate (41.5%), and severe (33.9%). The study also indicated that patient report of pain relief is inversely related to the average pain intensity reported (Moryl et al., 2018). These data suggest that assessing and managing a cancer patient’s pain is critical and there remains significant room for improvement in assessing and mitigating cancer-related pain. A prospective study of changes in pain severity of cancer patients found that, at initial assessment, 47% of patients reported pain. At follow-up, the patients with pain at initial assessment reported reduced pain (32.2%), stable pain (48.2%) and worse pain (19.6%). Of the 53% of patients reporting no pain at initial assessment, 82.6% reported stable pain and 17.4% reported worse pain at follow-up assessment (Zhao et al., 2014). This study highlights the importance of initial and ongoing assessments of pain to identify gaps and ensure proper pain management. |
Pain is a commonly occurring symptom for cancer patients as 30% to 50% (510,000 to 850,000 each year based on current statistics) will experience moderate to severe pain (Wiffen, Wee, Derry, Bell, & Moore, 2017). Initial and ongoing pain assessments are essential to determine the pathophysiology of pain and ensure proper pain management. According to the National Comprehensive Cancer Network (NCCN, 2025), risk factors for undertreatment of pain include people who are older, female, or historically marginalized, patients with communication barriers or a history of substance use disorder, patients with neuropathic pain, and patients with cultural factors. Undertreatment of pain remains a problem among a significant subset of cancer patients, survival is linked with symptom control and pain management, and pain management contributes to broad quality of life improvement. Furthermore, NCCN notes that formal pain reevaluation is required at each contact to ensure that pain management therapies are successfully meeting patient-specific goals for comfort, function, and safety. Cancer patients have reported that pain interferes with their mood, work, relationships with other people, sleep and overall enjoyment of life (Moryl et al., 2018). Pain management is an essential part of oncologic management and contributes to a patient’s overall function and quality of life (NCCN, 2025). A recent analysis of registry data for chronic pain cancer patients found average pain intensity reported as mild (24.6% of patients), moderate (41.5%), and severe (33.9%). The study also indicated that patient report of pain relief is inversely related to the average pain intensity reported (Moryl et al., 2018). These data suggest that assessing and managing a cancer patient’s pain is critical and there remains significant room for improvement in assessing and mitigating cancer-related pain. A prospective study of changes in pain severity of cancer patients found that, at initial assessment, 47% of patients reported pain. At follow-up, the patients with pain at initial assessment reported reduced pain (32.2%), stable pain (48.2%) and worse pain (19.6%). Of the 53% of patients reporting no pain at initial assessment, 82.6% reported stable pain and 17.4% reported worse pain at follow-up assessment (Zhao et al., 2014). This study highlights the importance of initial and ongoing assessments of pain to identify gaps and ensure proper pain management. |
| Clinical Recommendation Statement |
-Screen all patients for pain at each contact. -Routinely quantify and document pain intensity and quality as characterized by the patient (whenever possible). Include patient reporting of breakthrough pain, treatments used and their impact on pain, satisfaction with pain relief, pain interference, provider assessment of impact on function, and any special issues for the patient relevant to pain treatment. If necessary, get additional information from caregiver regarding pain and impact on function. -Perform comprehensive pain assessment if new or worsening pain is present and regularly for persisting pain. Various methods and tools exist to assess pain severity. Intensity of pain should be quantified using a numerical rating scale (i.e., 0-10), visual analog scale, categorical scale, or pictorial scale (e.g., The Faces Pain Rating Scale) (Category 2A) (National Comprehensive Cancer Network, 2022). |
-Screen all patients for pain at each contact. -Routinely quantify and document pain intensity and quality as characterized by the patient (whenever possible). Include patient reporting of breakthrough pain, treatments used and their impact on pain, satisfaction with pain relief, pain interference, provider assessment of impact on function, and any special issues for the patient relevant to pain treatment. If necessary, get additional information from caregiver regarding pain and impact on function. -Perform comprehensive pain assessment if new or worsening pain is present and regularly for persisting pain. Various methods and tools exist to assess pain severity. Intensity of pain should be quantified using a numerical rating scale (i.e., 0-10), visual analog scale, categorical scale, or pictorial scale (e.g., The Faces Pain Rating Scale) (Category 2A) (National Comprehensive Cancer Network, 2023). |
-Screen all patients for pain at each contact. -Routinely quantify and document pain intensity and quality as characterized by the patient (whenever possible). Include patient reporting of breakthrough pain, treatments used and their impact on pain, satisfaction with pain relief, pain interference, provider assessment of impact on function, and any special issues for the patient relevant to pain treatment and access to care. If necessary, get additional information from caregiver regarding pain and impact on function. -Perform comprehensive pain assessment if new or worsening pain is present and regularly for persisting pain. Various methods and tools exist to assess pain severity. Intensity of pain should be quantified using a numerical rating scale (i.e., 0-10), visual analog scale, categorical scale, or pictorial scale (e.g., The Faces Pain Rating Scale) (Category 2A) (National Comprehensive Cancer Network, 2024). |
|
| Improvement Notation |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
| Definition |
None |
None |
None |
None |
| Guidance |
This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients with a diagnosis of cancer who are also currently receiving chemotherapy or radiation therapy during the measurement period. For patients receiving radiation therapy, pain intensity should be quantified at each radiation treatment management encounter where the patient and physician have a face-to-face or telehealth interaction. Due to the nature of some applicable coding related to radiation therapy (e.g., delivered in multiple fractions), the billing date for certain codes may or may not be the same as the face-to-face or telehealth encounter date. In this instance, for the reporting purposes of this measure, the billing date should be used to pull the appropriate patients into the initial population. It is expected, though, that the numerator criteria would be performed at the time of the actual face-to-face or telehealth encounter during the series of treatments. A lookback (retrospective) period of 7 days, including the billing date, may be used to identify the actual face-to-face or telehealth encounter, which is required to assess the numerator. Therefore, pain intensity should be quantified during the face-to-face or telehealth encounter occurring on the actual billing date or within the 6 days prior to the billing date. For patients receiving chemotherapy, pain intensity should be quantified at each face-to-face or telehealth encounter with the physician while the patient is currently receiving chemotherapy. For purposes of identifying eligible encounters, patients "currently receiving chemotherapy" refers to patients administered chemotherapy on the same day as the encounter or during the 30 days before the date of the encounter AND during the 30 days after the date of the encounter. Pain intensity should be quantified using a standard instrument, such as a 0-10 numerical rating scale, visual analog scale, a categorical scale, or pictorial scale. Examples include the Faces Pain Rating Scale and the Brief Pain Inventory (BPI). 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 an episode-based measure. An episode is defined as each eligible encounter for patients with a diagnosis of cancer who are also currently receiving chemotherapy or radiation therapy during the measurement period. For patients receiving radiation therapy, pain intensity should be quantified at each radiation treatment management encounter where the patient and physician have a face-to-face or telehealth interaction. Due to the nature of some applicable coding related to radiation therapy (e.g., delivered in multiple fractions), the billing date for certain codes may or may not be the same as the face-to-face or telehealth encounter date. In this instance, for the reporting purposes of this measure, the billing date should be used to pull the appropriate patients into the initial population. It is expected, though, that the numerator criteria would be performed at the time of the actual face-to-face or telehealth encounter during the series of treatments. A lookback (retrospective) period of 7 days, including the billing date, may be used to identify the actual face-to-face or telehealth encounter, which is required to assess the numerator. Therefore, pain intensity should be quantified during the face-to-face or telehealth encounter occurring on the actual billing date or within the 6 days prior to the billing date. For patients receiving chemotherapy, pain intensity should be quantified at each face-to-face or telehealth encounter with the physician while the patient is currently receiving chemotherapy. For purposes of identifying eligible encounters, patients "currently receiving chemotherapy" refers to patients administered chemotherapy on the same day as the encounter or during the 30 days before the date of the encounter AND during the 30 days after the date of the encounter. Pain intensity should be quantified using a standard instrument, such as a 0-10 numerical rating scale, visual analog scale, a categorical scale, or pictorial scale. Examples include the Faces Pain Rating Scale and the Brief Pain Inventory (BPI). 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 an episode-based measure. An episode is defined as each eligible encounter for patients with a diagnosis of cancer who are also currently receiving chemotherapy or radiation therapy during the measurement period. For patients receiving radiation therapy, pain intensity should be quantified at each radiation treatment management encounter where the patient and physician have a face-to-face interaction. Due to the nature of some applicable coding related to radiation therapy (e.g., delivered in multiple fractions), the billing date for certain codes may or may not be the same as the face-to-face encounter date. In this instance, for the reporting purposes of this measure, the billing date should be used to pull the appropriate patients into the initial population. It is expected, though, that the numerator criteria would be performed at the time of the actual face-to-face encounter during the series of treatments. A lookback (retrospective) period of 7 days, including the billing date, may be used to identify the actual face-to-face encounter, which is required to assess the numerator. Therefore, pain intensity should be quantified during the face-to-face encounter occurring on the actual billing date or within the 6 days prior to the billing date. For patients receiving chemotherapy, pain intensity should be quantified at each face-to-face or telehealth encounter with the physician while the patient is currently receiving chemotherapy. For purposes of identifying eligible encounters, patients "currently receiving chemotherapy" refers to patients administered chemotherapy on the same day as the encounter or during the 30 days before the date of the encounter AND during the 30 days after the date of the encounter. Pain intensity should be quantified using a standard instrument, such as a 0-10 numerical rating scale, visual analog scale, a categorical scale, or pictorial scale. Examples include the Faces Pain Rating Scale and the Brief Pain Inventory (BPI). 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 an episode-based measure. An episode is defined as each eligible encounter for patients with a diagnosis of cancer who are also currently receiving chemotherapy or radiation therapy during the measurement period.
This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
| Initial Population |
All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy |
Population 1: All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy Population 2: All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving radiation therapy |
Population 1: All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy Population 2: All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving radiation therapy |
Population 1: All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy. Population 2: All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving radiation therapy. |
| Denominator |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
| Denominator Exclusions |
None |
None |
None |
None |
| Numerator |
Patient visits in which pain intensity is quantified |
Patient visits in which pain intensity is quantified |
Patient visits in which pain intensity is quantified |
Patient visits in which pain intensity is quantified. |
| Numerator Exclusions |
Not Applicable |
Not Applicable |
None |
None |
| Denominator Exceptions |
None |
None |
None |
None |
| Telehealth Eligible | Yes | Yes | Yes | Yes |
| Next Version | No Version Available | |||
| Previous Version | No Version Available |
Additional Resources for CMS157v15
Header
| TRN | Measure Section | Source of Change |
|---|---|---|
Updated the eCQM version number. | eCQM Version Number | Annual Update |
Updated the measurement period from 'January 1, 2026 through December 31, 2026' to 'January 1, 2027 through December 31, 2027.' | Measurement Period | Annual Update |
Updated copyright. | Copyright | Annual Update |
Updated grammar, wording, and/or formatting to improve readability and consistency. | Multiple Sections | Annual Update |
Updated disclaimer. | Disclaimer | Annual Update |
Updated references and measure header to reflect current evidence and new or updated literature. | Multiple Sections | Measure Lead |
Updated all in-text citations from APA6 style to APA7 style. | Multiple Sections | Standards/Technical Update |
Updated all References from APA6 style to APA7 style. | Reference | Standards/Technical Update |
Logic
| TRN | Measure Section | Source of Change |
|---|---|---|
Updated CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide. | Definitions | Standards/Technical Update |
Updated all logic definitions to be written in initial case for alignment with the CQL Style Guide. | Definitions | Standards/Technical Update |
Updated measure logic to remove the logic clause related to the Direct Reference Code for 5 radiation treatments (CPT 77427). | Definitions | Annual Update |
Revised 'Face To Face Or Telehealth Encounter With Ongoing Chemotherapy' definition to streamline logic and improve readability. | Definitions | Annual Update |
Removed Direct Reference Code for 5 radiation treatments (CPT 77427) based on SME/Expert recommendations. | Terminology | 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.
| TRN | Measure Section | Source of Change |
|---|---|---|
Value Set 'Cancer' (2.16.840.1.113883.3.526.3.1010): Added 3 ICD10CM codes (C50.A0, C50.A1, C50.A2) based on code system/terminology updates. Deleted 14 ICD10CM codes (C86.0, C88.8, C88.4, C86.5, C83.39, C88.2, C88.9, C86.4, C88.0, C86.2, C86.6, C86.3, C86.1, C88.3) based on code system/terminology updates. Added 4 SNOMEDCT codes (1304123001, 1354521001, 1359852007, 1359859003) based on code system/terminology updates. | Terminology | Annual Update |
Value Set 'Chemotherapy Administration' (2.16.840.1.113883.3.526.3.1027): Deleted 14 SNOMEDCT codes (1141994004, 1254741007, 1254742000, 455281000124104, 455291000124101, 461391000124102, 716872004, 722472009, 722482005, 722491009, 870249004, 870250004, 897713009, 169398009) based on code system/terminology updates and SME/Expert recommendations. | Terminology | Annual Update |
Value Set 'Office Visit' (2.16.840.1.113883.3.464.1003.101.12.1001): Added 8 CPT codes (98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007) based on SME/Expert recommendations. Added 2 SNOMEDCT codes (30346009, 37894004) based on SME/Expert recommendations. | Terminology | Annual Update |
Value Set 'Payer Type' (2.16.840.1.114222.4.11.3591): Deleted 42 SOPT codes (111, 1112, 3111, 3112, 3114, 3115, 3116, 3119, 3121, 3122, 3211, 3212, 32121, 32122, 32123, 32124, 32125, 32126, 32127, 32128, 3222, 3223, 3229, 3711, 3712, 3713, 3811, 3812, 3813, 3819, 6, 61, 611, 612, 613, 614, 619, 62, 621, 622, 623, 629) based on new or changed coding guidance. | Terminology | Annual Update |