To MPM’s knowledge there is not an established process with the health plans that captures this information, but we think it is something important that needs to be established. For BCS, transgender women should not be automatically excluded because they are at slightly higher risk of breast cancer due to hormone therapy, but the following can be used:
Z90.13 Absence of both breasts (which is also the code for bilateral mastectomy).
For the time being we will need to upload records for these patients to get them excluded from the CCS & BCS metric. In the interim, MPM will inquire with the health plans how we can better identify and exclude members from specific metrics by accounting for their birth sex.