Positive PD-L1 Biomarker Expression Test Result Prior to First-Line Immune Checkpoint

Measure Specification

The evidence-based NCCN Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer and NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancer address the measure’s quality actions of a positive PD-L1 biomarker expression test prior to giving first-line immune checkpoint inhibitor therapy in the metastatic NSCLC or squamous cell carcinoma of head and neck populations.

The measure will enhance compliance with the clinical guidelines by ensuring the eligible provider addresses timely biomarker testing that makes a difference in treatment decisions and improves patient outcomes.

Biomarker testing that is not timely may make a difference in treatment decisions and/or patient outcomes. Appropriate treatment delivery could be delayed, or ineffective therapies could be prescribed, resulting in poor clinical outcomes and unnecessary healthcare costs (Pai et al., 20120 Lim et al., 2015).

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient during the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.