Primary Caries Prevention Intervention as Offered by Dentists

Compare Versions of: "Primary Caries Prevention Intervention as Offered by Dentists"

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Measure Information	2023 Performance Period	2024 Performance Period	2025 Performance Period
Title	Primary Caries Prevention Intervention as Offered by Dentists	Primary Caries Prevention Intervention as Offered by Dentists	Primary Caries Prevention Intervention as Offered by Dentists
CMS eCQM ID	CMS74v12	CMS74v13	CMS74v14
CBE ID*	Not Applicable	Not Applicable	Not Applicable
MIPS Quality ID	379	379	379
Measure Steward	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, who received a fluoride varnish application during the measurement period as determined by a dentist	Percentage of children, 1 - 20 years of age, who received two fluoride varnish applications during the measurement period as determined by a dentist	Percentage of children, 1-20 years of age, who received two fluoride varnish applications during the measurement period as determined by a dentist
Measure Scoring	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process	Process	Process
Stratification	*See CMS74v12.html	Population 1: Patients age 1-5 years at the start of the Measurement Period Population 2: Patients age 6-12 years at the start of the Measurement Period Population 3: Patients age 13-20 years at the start of the Measurement Period	Population 1: Patients age 1-5 years at the start of the Measurement Period Population 2: Patients age 6-12 years at the start of the Measurement Period Population 3: Patients age 13-20 years at the start of the Measurement Period
Risk Adjustment	*See CMS74v12.html	None	None
Rationale	*See CMS74v12.html	The literature reflects that fluoride varnish, when applied to the teeth of high-risk children, reduces, in conjunction with anticipatory guidance provided to the caregiver, the risk of the child developing caries (Weyant et al., 2013). Evidence in the literature also specifically... supports the effectiveness of professionally applied fluoride varnish at preventing caries in higher risk children (Chou et al., 2014). Show more > The literature reflects that fluoride varnish, when applied to the teeth of high-risk children, reduces, in conjunction with anticipatory guidance provided to the caregiver, the risk of the child developing caries (Weyant et al., 2013). Evidence in the literature also specifically supports the effectiveness of professionally applied fluoride varnish at preventing caries in higher risk children (Chou et al., 2014). Show less	The literature reflects that fluoride varnish, when applied to the teeth of high-risk children, reduces, in conjunction with anticipatory guidance provided to the caregiver, the risk of the child developing caries (Weyant et al., 2013). Evidence in the literature also specifically... supports the effectiveness of professionally applied fluoride varnish at preventing caries in higher risk children (Chou et al., 2014). Show more > The literature reflects that fluoride varnish, when applied to the teeth of high-risk children, reduces, in conjunction with anticipatory guidance provided to the caregiver, the risk of the child developing caries (Weyant et al., 2013). Evidence in the literature also specifically supports the effectiveness of professionally applied fluoride varnish at preventing caries in higher risk children (Chou et al., 2014). Show less
Clinical Recommendation Statement	*See CMS74v12.html	The 2013 American Dental Association (ADA) clinical recommendations for use of professionally applied or prescription-strength, home-use topical fluorides for caries prevention in patients at elevated risk of developing caries: - Younger Than 6 Years - 2.26 percent fluoride varnish at... least every three to six months - 6-18 Years - 2.26 percent fluoride varnish at least every three to six months OR 1.23 percent fluoride (APF) gel for four minutes at least every three to six months - Older Than 18 Years - 2.26 percent fluoride varnish at least every three to six months OR 1.23 percent fluoride (APF) gel for four minutes at least every three to six months (Weyant et al., 2013) The United States Preventive Services Taskforce (USPSTF) recommends the use of professionally applied fluoride varnish for the prevention of dental caries in high risk children under 5 years of age (Chou et al., 2014). Show more > The 2013 American Dental Association (ADA) clinical recommendations for use of professionally applied or prescription-strength, home-use topical fluorides for caries prevention in patients at elevated risk of developing caries: - Younger Than 6 Years - 2.26 percent fluoride varnish at least every three to six months - 6-18 Years - 2.26 percent fluoride varnish at least every three to six months OR 1.23 percent fluoride (APF) gel for four minutes at least every three to six months - Older Than 18 Years - 2.26 percent fluoride varnish at least every three to six months OR 1.23 percent fluoride (APF) gel for four minutes at least every three to six months (Weyant et al., 2013) The United States Preventive Services Taskforce (USPSTF) recommends the use of professionally applied fluoride varnish for the prevention of dental caries in high risk children under 5 years of age (Chou et al., 2014). Show less	The 2013 American Dental Association (ADA) clinical recommendations for use of professionally applied or prescription-strength, home-use topical fluorides for caries prevention in patients at elevated risk of developing caries: - Younger Than 6 Years - 2.26 percent fluoride varnish at... least every three to six months. - 6-18 Years - 2.26 percent fluoride varnish at least every three to six months OR 1.23 percent fluoride (APF) gel for four minutes at least every three to six months. - Older Than 18 Years - 2.26 percent fluoride varnish at least every three to six months OR 1.23 percent fluoride (APF) gel for four minutes at least every three to six months (Weyant et al., 2013). The United States Preventive Services Taskforce (USPSTF) recommends the use of professionally applied fluoride varnish for the prevention of dental caries in high risk children under 5 years of age (Chou et al., 2014). Show more > The 2013 American Dental Association (ADA) clinical recommendations for use of professionally applied or prescription-strength, home-use topical fluorides for caries prevention in patients at elevated risk of developing caries: - Younger Than 6 Years - 2.26 percent fluoride varnish at least every three to six months. - 6-18 Years - 2.26 percent fluoride varnish at least every three to six months OR 1.23 percent fluoride (APF) gel for four minutes at least every three to six months. - Older Than 18 Years - 2.26 percent fluoride varnish at least every three to six months OR 1.23 percent fluoride (APF) gel for four minutes at least every three to six months (Weyant et al., 2013). The United States Preventive Services Taskforce (USPSTF) recommends the use of professionally applied fluoride varnish for the prevention of dental caries in high risk children under 5 years of age (Chou et al., 2014). Show less
Improvement Notation	A higher score indicates better quality	A higher score indicates better quality	A higher score indicates better quality
Definition	*See CMS74v12.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 5.6. Please refer... to the QDM page for more information on the QDM. Show more > 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. Show less	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. Show more > 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. Show less	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. Show more > 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. Show less
Initial Population	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
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
Numerator	Children who receive a fluoride varnish application during the measurement period	Children who receive two fluoride varnish applications on different days during the measurement period	Children who receive two fluoride varnish applications on different days during the measurement period
Numerator Exclusions	Not Applicable	Not Applicable	Not Applicable
Denominator Exceptions	None	None	None
Telehealth Eligible	No	No	No
Next Version	CMS74v13	CMS74v14	No Version Available
Previous Version	No Version Available	CMS74v12	CMS74v13

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Specifications

Additional Resources for CMS74v13

CMS74v13-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 the measure to require two fluoride applications as opposed to one fluoride application to reflect current evidence and clinical recommendations, and to align with similar quality measures.
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: Stratification
Source of Change: Measure Lead
Updated the rationale based upon more recent literature and evidence to support the measure.
Measure Section: Rationale
Source of Change: Measure Lead
Updated the clinical recommendation statement based upon more recent literature and evidence to support the measure.
Measure Section: Clinical Recommendation Statement
Source of Change: Measure Lead
Updated references.
Measure Section: Reference
Source of Change: Measure Lead
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
Updated the measure to require two fluoride applications as opposed to one fluoride application to reflect current evidence and clinical recommendations, and to align with similar quality measures.
Measure Section: Numerator
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
Updated the measure to require two fluoride applications as opposed to one fluoride application to reflect current evidence and clinical recommendations, and to align with similar quality measures.
Measure Section: Numerator
Source of Change: Measure Lead
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: Stratification
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