Breast Cancer Screening (BCS)

What Is the Measure?

This measure looks at the percentage of women 50 to 74 years of age who had a mammography study performed any time during the measurement period (October 1st two years prior to measurement year through December 31st of measurement year).

Eligible Codes

2.1

2.2

2.3

2.4

2.5

Exclusions

• Bilateral mastectomy or unilateral mastectomy with a bilateral modifier at any time during their history through the end of the measurement year

• Hospice care

• Palliative care during the measurement year

• Members 66 years of age and older as of December 31st of the measurement year, with frailty and advanced illness (must meet both frailty and advanced illness for exclusion)

• Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia (cholinesterase inhibitors or central nervous system agents) during the measurement period or the year prior to the measurement period

History of breast cancer without a bilateral mastectomy is not an exclusion for this measure. Patient refusal is not an exclusion for this measure.

How to Improve Score

• Discuss the importance of breast cancer screening and ensure your patients are up to date with their annual mammogram.

• Document the screening for breast cancer in the medical record. The medical record must indicate specific date and result of the screening. MRIs, ultrasounds, or biopsies do not count in this measure.

• Document medical and surgical history of the breast in the medical record, including dates.

• Submit the appropriate diagnosis and procedure codes for the services rendered.

• Submit claims and encounter data in an accurate and timely manner.

For Broward Guardian Providers

• It is required that you document the date and results of the most recent mammogram.

2.6

2.7

2.8

2.9

2.10