• Chemotherapy Encounters: Updated the logic to capture qualifying chemotherapy encounters occurring on the patient’s initial pain assessment date, up to 30 days prior to the initial pain encounter, and up to 30 days following the initial pain encounter, ensuring all eligible treatment activity is considered during measure evaluation.
• Radiation Therapy Encounters: Updated the logic to include during the initial pain assessment, the radiation therapy encounters fall within a 7-day lookback period (billing date plus the previous 6 days) for face-to-face radiation therapy encounters, ensuring eligible encounters are appropriately captured in the measure calculation.

Numerator

• December data has been incorporated into the calculation logic. For patients with a 30-day follow-up occurring in January, the measure will now look back into December of the previous year to capture any qualifying pain improvement documented during the January follow-up period.

• Staging Update: Refined the denominator logic to restrict eligibility to Stage IV patients, resulting in a more accurate representation of the measure population.
• Diagnosis Date Refinement: Implemented a stricter Stage IV NSCLC diagnosis date window, requiring the diagnosis date to fall between July 1 of the previous performance period and the end of the current performance period.
• First-Line Therapy Definition: Refined the measure logic so that first-line therapy initiation is determined by the first qualifying chemotherapy regimen occurring after the patient’s Stage IV diagnosis.

Denominator Exclusion

• Clinical Trial Exclusion Refinement: Updated the exclusion logic to ensure that only patients whose first-line chemotherapy regimen was administered as part of a clinical trial are excluded from the measure population.

Numerator

• The measure now follows two different evaluation paths based on the patient’s biomarker results:
  • Targeted Therapy Pathway for patients with a positive actionable biomarker (a biomarker that has a specific targeted treatment available).
  • Standard of Care / Immunotherapy Pathway for patients who do not have an actionable biomarker.
• Patients are now evaluated using the pathway that matches their biomarker results. To receive numerator credit, the patient’s treatment and timing must align with the requirements of the applicable pathway.

Treatment Transition Window

• Patients with conclusive biomarker results (positive or negative) documented within the allowable testing window, which includes up to 6 months prior to the first treatment date (1st chemo regimen after stage 4 diagnosis) or up to 6 weeks after the first treatment date.
• Clinicians are provided with a 6-week window following the patient’s first chemotherapy regimen after the Stage IV diagnosis to transition the patient to the appropriate treatment based on the biomarker test results.

Added 10 New Value Sets:

• “Dexamethasone Drug Implant” (2.16.840.1.113883.3.1444.3.150)
• “Dexamethasone Injectable” (2.16.840.1.113883.3.1444.3.149)
• “Dexamethasone Oral” (2.16.840.1.113883.3.1444.3.148)
• “Neurokinin 1 Receptor Antagonist Injectable” (2.16.840.1.113883.3.1444.5.274)
• “Neurokinin 1 Receptor Antagonist Oral” (2.16.840.1.113883.3.1444.5.273)
• “Olanzapine Injectable” (2.16.840.1.113883.3.1444.3.152)
• “Olanzapine Oral” (2.16.840.1.113883.3.1444.3.151)
• “Serotonin Receptor Antagonist Injectable” (2.16.840.1.113883.3.1444.5.276)
• “Serotonin Receptor Antagonist Oral” (2.16.840.1.113883.3.1444.5.275)
• “Serotonin Receptor Antagonist Transdermal” (2.16.840.1.113883.3.1444.5.277)

Removed 2 Value Sets

• “Antiemetic Agent” (2.16.840.1.113883.3.1444.5.245)
• “Neurokinin 1 Receptor Antagonist” (2.16.840.1.113762.1.4.1116.602)

Added 10 New Value Sets:

• “Dexamethasone Drug Implant” (2.16.840.1.113883.3.1444.3.150)
• “Dexamethasone Injectable” (2.16.840.1.113883.3.1444.3.149)
• “Dexamethasone Oral” (2.16.840.1.113883.3.1444.3.148)
• “Neurokinin 1 Receptor Antagonist Injectable” (2.16.840.1.113883.3.1444.5.274)
• “Neurokinin 1 Receptor Antagonist Oral” (2.16.840.1.113883.3.1444.5.273)
• “Olanzapine Injectable” (2.16.840.1.113883.3.1444.3.152)
• “Olanzapine Oral” (2.16.840.1.113883.3.1444.3.151)
• “Serotonin Receptor Antagonist Injectable” (2.16.840.1.113883.3.1444.5.276)
• “Serotonin Receptor Antagonist Oral” (2.16.840.1.113883.3.1444.5.275)
• “Serotonin Receptor Antagonist Transdermal” (2.16.840.1.113883.3.1444.5.277)

Removed 2 Value Sets

• “Antiemetic Agent” (2.16.840.1.113883.3.1444.5.245)
• “Neurokinin 1 Receptor Antagonist” (2.16.840.1.113762.1.4.1116.602)