Table 1. Measures of Low-Value Services Related to Primary Care.

Clinical Category	Measure	Operational Definitiona	Denominator Population
Cancer screening	Cervical cancer screening for women aged ≥65 y	Screening Papanicolaou test for women aged ≥65 y with no personal history of cancer or dysplasia noted in claim or in prior claims and no diagnoses of other female genital cancers, abnormal Papanicolaou findings, or human papillomavirus positivity in prior claims	Women aged ≥65 y
	Colorectal cancer screening for adults aged >85 y	Colorectal cancer screening (colonoscopy, sigmoidoscopy, barium enema, or fecal occult blood testing) for patients aged ≥86 y with no history of colon cancer	Patients aged >85 y
	PSA testing for men aged ≥75 y	PSA testing for patients aged ≥75 y with no history of prostate cancer	Men aged ≥75 y
Diagnostic and preventive testing	Bone mineral density testing at frequent intervals	Bone mineral density test within 2 y of a prior bone mineral density test for patients with an established osteoporosis diagnosis	Patients with osteoporosisb
	Hypercoagulability testing for patients with DVT	Laboratory tests for hypercoagulable states within 30 d after diagnosis of lower extremity DVT or pulmonary embolism; no prior evidence of recurrent thrombosis, defined by diagnosis of DVT or pulmonary embolism >90 d before the testing claim	Patients with DVTc
	Total or free T3 level testing for patients with hypothyroidism	Total or free T3 level measurement in a patient with a hypothyroidism diagnosis during the year	Patients with hypothyroidismc
Preoperative testing	Preoperative chest radiography	Chest radiography not associated with inpatient or ED care and occurring within 30 d before a low- or intermediate-risk noncardiothoracic surgical procedured	Patients undergoing selected surgical proceduresc
	Preoperative echocardiography	Echocardiography not associated with inpatient or ED care and occurring within 30 d before a low- or intermediate-risk noncardiothoracic surgical procedured	Patients undergoing selected surgical proceduresc
	Preoperative PFT	PFT not associated with inpatient or ED care and occurring within 30 d before a low- or intermediate-risk surgical proceduree	Patients undergoing selected surgical proceduresc
	Routine preoperative stress tests	Stress electrocardiography, echocardiography, nuclear medicine imaging, cardiac MRI, or CT angiography not associated with inpatient or ED care and occurring within 30 d before a low- or intermediate-risk surgical procedured	Patients undergoing selected surgical proceduresc
Imaging	CT of the sinuses for uncomplicated acute rhinosinusitis	Maxillofacial CT study with a diagnosis of sinusitis and no complications of sinusitis,f immune deficiencies, nasal polyps, or head and/or face trauma noted in claim and no sinusitis diagnosis from 30 to 365 d before imaging	All patients
	Back imaging for patients with nonspecific lower back pain	Back imaging with a diagnosis of lower back pain occurring within 6 wk of initial back pain diagnosis and with no indication of radiculopathy or other diagnoses in claim warranting imaginge	All patients
	Screening for carotid artery disease in asymptomatic adults	Carotid imaging not associated with inpatient or ED care for patients without a history of stroke or TIA and without a diagnosis of stroke, TIA, or focal neurologic symptoms in claim	All patients
	Imaging for diagnosis of plantar fasciitis	Radiographic imaging or MRI with diagnosis of plantar fasciitis occurring within 2 wk of initial foot pain diagnosis	Patients with fasciitis diagnosisc
Cardiovascular testing and procedures	Stress testing for stable coronary disease	Stress testing not associated with inpatient or ED careg for patients with an established diagnosis of acute myocardial infarction (≥6 mo before testing)	Patients with AMIh
Other procedures	Arthroscopic surgery for knee osteoarthritis	Arthroscopic debridement/chondroplasty of the knee with diagnosis of osteoarthritis or chondromalacia in the procedure claim and no meniscal tears noted in procedure claim	All patients
	Spinal injection for low back pain	Outpatient epidural, facet, or trigger point injections for lower back pain, excluding etanercept; no radiculopathy diagnoses in the claim	All patients

Abbreviations: AMI, acute myocardial infarction; CT, computed tomography; DVT, deep vein thrombosis; ED, emergency department; MRI, magnetic resonance imaging; PFT, pulmonary function testing; PSA, prostate-specific antigen; T₃, triiodothyronine; TIA, transient ischemic attack.

^aPrior claims indicates claims for services before the day of the measured service and during or after the prior calendar year. Unless otherwise indicated, inpatient-associated indicates occurring during within 30 d after an inpatient stay; ED-associated, during or 1 day after an ED visit.

^bDefined by the presence of Chronic Condition Data Warehouse first indication date before December 31 of the year.

^cDefined by presence of relevant diagnosis or service codes during the year.

^dIncludes breast procedures, colectomy, cholecystectomy, transurethral resection of the prostate, hysterectomy, orthopedic surgical procedures other than hip and knee replacement, corneal transplant, cataract removal, retinal detachment, hernia repair, lithotripsy, arthroscopy, and cholecystectomy.

^eIncludes procedures listed in note e as well as coronary artery bypass graft, aneurysm repair, thromboendarterectomy, percutaneous transluminal coronary angioplasty, and pacemaker insertion.

^fIncludes inflammation of eyelid or orbit, orbital cellulitis, and visual problems.

^gInpatient-associated is defined here as occurring during an inpatient stay; ED-associated, during or within 14 days after an ED visit.

^hExclusion diagnoses include cancer, trauma, intravenous drug abuse, neurologic impairment, endocarditis, septicemia, tuberculosis, osteomyelitis, fever, weight loss, loss of appetite, night sweats, and anemia.