Chlamydia Screening in Women - Exploratory Measure Tip Sheet

This is an exploratory measure; there is no payment for 2023 and 2024. For additional information, refer to the CBI Technical Specifications.

Members who are age 16 to 24 years old, as of the end of the measurement year, and who were determined to be sexually active. Sexual activity is determined by:

• Pregnancy test or diagnosis.
• Claim/encounter noting sexual activity.
• Contraceptive medication (see CBI Technical Specifications for a full list of medications).

Members in hospice or using hospice services anytime during the measurement year.

Members who died any time during the measurement year (CBI 2024 only).

For the members identified based on a pregnancy test alone, they will be removed from the measure for either of the following:

• A pregnancy test during the measurement year and a prescription for isotretinoin (retinoid) on the date of the pregnancy test or the six days after the pregnancy test.
• A pregnancy test during the measurement year and an X-ray on the date of the pregnancy test, or the six days after the pregnancy test.

Chlamydia Screening CPT Codes: 87110, 87270, 87320, 87490, 87491, 87492, 87810

See the full list of chlamydia screening and exclusion codes in the CBI Technical Specifications.

Data for this measure will be collected using claims, laboratory data, pharmacy data, and provider data submissions via the Data Submission Tool (DST) on the Provider Portal. To find gaps in data:

• Run a report from your electronic health record (EHR) system; or
• Manually compile patient data (Example: Download monthly chlamydia screening quality report or your Care-Based Incentives Measure Details report on the Provider Portal and compare to your EHR/paper charts).

This measure allows providers to submit chlamydia screening test results from the clinic EHR system or paper records to the Alliance by the DST contractual deadline. To submit, you may upload data files to the DST on the Provider Portal. To be accepted, data must be submitted as a CSV file. Step-by-step instructions are available in the Data Submission Tool Guide on the Provider Portal.

• CDC recommends yearly STI screenings at well-visits.
• American Academy of Pediatrics opt-out approach for chlamydia screenings.
  • Opt-Out Chlamydia Screening Should Be Part of Routine Adolescent Health Care Services. Discuss sexual activity and remind members of safe sex practices. Screen if member mentions a new sexual partner or other risk factors.
• Establish routine clinic flow processes for routine screenings and ensure time alone with adolescents and time to confidentially collect specimens if accompanied by their parents.
• Consult the “Chlamydia Screening Starter Guide” for more strategies and guidelines.
• Consider the community you serve and consult the local health department to identify groups that are at increased risk in your area.
• Establish a recall system using the Provider Portal Quality Reports.
• Have a written policy and protocol.
• When screening for STIs, the United States Preventive Services Task Force (USPSTF) recommends:
  • HIV screening: Should be performed for everyone ages 15-65 (USPSTF). Younger adolescents and older adults who are at increased risk of infection should also be screened.
  • Screening adolescents and young adults < 25 years: Annual chlamydia and gonorrhea screenings should be performed for women < 25 years of age and older women at risk. Syphilis, HIV, chlamydia and hepatitis B screenings should be given to all pregnant women. gonorrhea screenings should be given to pregnant women at risk.
• Refer to the CDC’s A Guide to Taking a Sexual History for a sample of discussion points and questions that may be asked.
• Refer to CDC Sexually Transmitted Infections Treatment Guidelines, 2021 for up-to-date clinical guidelines.

• Alliance interpreting services are available to network providers:
  • Telephonic interpreting services are available to assist in scheduling members.
  • Face-to-face interpreters can be requested to be at the appointment with the member.

  For information about our Cultural and Linguistic Services Program, please call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].

• Refer patients who have transportation challenges to the Alliance’s Transportation Coordinator at 800-700-3874, ext. 5577. This service is not covered for non-medical locations or for appointments that are not medically necessary.
• NCQA’s Improving Chlamydia Screening Strategies from Top Performing Health Plans