Lumpectomy, Partial Mastectomy, Simple Mastectomy - ICD-10-CM Quality Payment Program Measure

Quality Measure Description High Priority Submission Methods
Lumpectomy, Partial Mastectomy, Simple MastectomyEpisode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care ("episode"). In all supplemental documentation, "cost" generally means the standardized Medicare allowed amount, and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Lumpectomy, Partial Mastectomy, Simple Mastectomy episode-based cost measure evaluates a clinician's risk-adjusted cost to Medicare for patients who undergo partial or total mastectomy for breast cancer during the performance period. The measure score is the clinician's risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician. This procedural measure includes costs of services that are clinically related to the attributed clinician's role in managing care during each episode from 30 days prior to the clinical event that opens, or "triggers," the episode through 90 days after the trigger.NOAdministrativeclaims

Linked ICD-10 Codes

The following ICD-10-CM codes are linked to the quality measure lumpectomy, partial mastectomy, simple mastectomy when used as part of a patient's medical record. This Quality Measure is part of Medicare's Quality Payment Program (QPP).

ICD CodeDescriptionCategory

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