DMS: Use of Imaging Studies for Low Back Pain
Percentage of acute LBP episodes (no red flags) that did NOT have imaging in first 28 days. Choosing Wisely aligned.
Measure description
Percentage of acute LBP episodes (no red flags) that did NOT have imaging in first 28 days. Choosing Wisely aligned.
Eligible population
Members with new LBP episode
Performance drivers
Overuse of imaging for non-radiculopathic LBP.
Documentation & PA strategy
Document no red flags (cauda equina, history of CA, IVDU, trauma); conservative care plan. PA for imaging often requires red flag documentation.
Why HEDIS matters for prior authorization
Health plans align prior authorization criteria with HEDIS measures: documenting your patient meets the HEDIS definition often streamlines or eliminates PA hurdles. For Medicare Advantage in particular, plans are heavily incentivized via Star Ratings to push members and providers toward measure compliance, which translates into faster approvals for measure-aligned services.
Frequently asked questions
What does HEDIS measure DMS measure?
Percentage of acute LBP episodes (no red flags) that did NOT have imaging in first 28 days. Choosing Wisely aligned.
What drives performance on this measure?
Overuse of imaging for non-radiculopathic LBP.
How should clinicians document for this measure?
Document no red flags (cauda equina, history of CA, IVDU, trauma); conservative care plan. PA for imaging often requires red flag documentation.
What is the eligible population?
Members with new LBP episode
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