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MRI Lumbar Spine for Low Back Pain

CBE ID
0514
Endorsed
Endorsement Status
1.1 New or Maintenance
E&M Cycle
Is Under Review
No
1.3 Measure Description

This measure evaluates the percentage of magnetic resonance imaging (MRI) of the lumbar spine studies for low back pain performed in the outpatient setting where conservative therapy was not attempted prior to the MRI. Antecedent conservative therapy may include claim(s) for physical therapy in the 60 days preceding the lumbar spine MRI, claim(s) for chiropractic evaluation and manipulative treatment in the 60 days preceding the lumbar spine MRI, or claim(s) for evaluation and management at least 28 days but no later than 60 days preceding the lumbar spine MRI. The measure is calculated based on a one-year window of Medicare claims data. The measure has been publicly reported, annually, by the measure steward, the Centers for Medicare & Medicaid Services (CMS), since 2010, as a component of its Hospital Outpatient Quality Reporting (HOQR) Program.

        • 1.14 Numerator

          MRI of the lumbar spine studies with a diagnosis of low back pain (from the denominator) without the patient having claims-based evidence of prior antecedent conservative therapy.

        • 1.15 Denominator

          The number of MRI of the lumbar spine studies with a diagnosis of low back pain on the imaging claim performed in a hospital outpatient department on Medicare FFS beneficiaries within a 12-month time window.

        • Exclusions

          Below, in Section S.11 we provide a detailed list of denominator exclusion conditions. Denominator exclusions are consistent with current guidelines, evidence in literature, and guidance from the measure TEP.

        • Most Recent Endorsement Activity
          Measure Retired and Endorsement Removed 2016-2017 Off-Cycle Activities: Measure Review
          Initial Endorsement
          Last Updated
          Removal Date