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.
Measure Specs
General Information
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.
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.
Measure Record
Point of Contact
This measure does not have a copyright.
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