Quality Measure Explorer: MIPS & QCDR Measures, 2026

Search every 2026 quality measure by name, ID, or condition

Search 162 MIPS quality measures and 4 VBCA-developed QCDR measures for the 2026 performance year. Each measure includes specifications, benchmarks, and editorial analysis. For requirements and deadlines, read the 2026 MIPS reporting guide.

Jump toHigh-priority measures VBCA QCDR measures Specialty sets

The 2026 measure set

CMS MIPS quality measures: 162
flagged high priority by CMS: 107
VBCA QCDR measures, approved by CMS: 4
specialty measure sets: 48

Showing 162 measures

MIPS 001Intermediate Outcome – High Priority

Diabetes: Glycemic Status Assessment Greater Than 9%

Percentage of patients 18-75 years of age with diabetes who had a glycemic status assessment (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) > 9.0% during the measurement period.

BenchmarkDiabetesMIPS CQM · Medicare Part B Claims · eCQM

MIPS 005Process

Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD)

Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) ≤ 40% who were prescribed ACE inhibitor or ARB or ARNI therapy either within a 12-month period when seen in the outpatient setting OR at each hospital discharge.

Topped outHeart FailureMIPS CQM · eCQM

MIPS 006Process

Coronary Artery Disease (CAD): Antiplatelet Therapy

Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease (CAD) seen within a 12-month period who were prescribed aspirin or clopidogrel.

Topped outCardiologyMIPS CQM

MIPS 007Process

Coronary Artery Disease (CAD): Beta-Blocker Therapy – Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF ≤ 40%)

Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior LVEF ≤ 40% who were prescribed beta-blocker therapy.

Topped outCardiologyMIPS CQM · eCQM

MIPS 008Process

Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) ≤ 40% who were prescribed beta-blocker therapy either within a 12-month period when seen in the outpatient setting OR at each hospital discharge.

Topped outHeart FailureMIPS CQM · eCQM

MIPS 024Process – High Priority

Communication with the Physician or Other Clinician Managing On-Going Care Post-Fracture for Men and Women Aged 50 Years and Older

Percentage of patients aged 50 years and older treated for a fracture with documentation of communication, between the physician treating the fracture and the physician or other clinician managing the patient’s on-going care, that a fracture occurred and that the patient was or should be considered for osteoporosis treatment or testing. This measure is submitted by the physician who treats the fracture and who therefore is held accountable for the communication.

Topped outCare CoordinationMIPS CQM · Medicare Part B Claims

MIPS 039Process

Screening for Osteoporosis for Women Aged 65-85 Years of Age

Percentage of women 65-85 years of age who ever had a central dual-energy X-ray absorptiometry (DXA) test to check for osteoporosis.

BenchmarkOsteoporosisMIPS CQM · Medicare Part B Claims

MIPS 047Process – High Priority

Advance Care Plan

Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan.

Topped outAdvance Care PlanningMIPS CQM · Medicare Part B Claims

MIPS 048Process

Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older

Percentage of female patients aged 65 years and older who were assessed for the presence or absence of urinary incontinence within 12 months.

Topped outFunctional AssessmentMIPS CQM

MIPS 050Process – High Priority

Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older

Percentage of female patients aged 65 years and older with a diagnosis of urinary incontinence with a documented plan of care for urinary incontinence at least once within 12 months.

Topped outFunctional AssessmentMIPS CQM

MIPS 052Process

Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation and Long-Acting Inhaled Bronchodilator Therapy

Percentage of patients aged 18 years and older with a diagnosis of COPD with a documented FEV1/FVC < 70% measured by spirometry, who are symptomatic, and were prescribed a long-acting inhaled bronchodilator.

Topped outPulmonologyMIPS CQM

MIPS 065Process – High Priority

Appropriate Treatment for Upper Respiratory Infection (URI)

Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic order.

Topped outAppropriate UseMIPS CQM · eCQM

MIPS 066Process – High Priority

Appropriate Testing for Pharyngitis

The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order on or within 3 days after the episode date and a group A Streptococcus (Strep) test in the seven-day period from three days prior to the episode date through three days after the episode date.

Topped outAppropriate UseMIPS CQM · eCQM

MIPS 102Process – High Priority

Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients

Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low (or very low) risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy who did not have a bone scan performed at any time since diagnosis of prostate cancer.

BenchmarkAppropriate UseMIPS CQM · eCQM

MIPS 117Process

Diabetes: Eye Exam

Percentage of patients 18-75 years of age with diabetes and an active diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or diabetics with no diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam during the measurement period or in the 12 months prior to the measurement period.

Topped outDiabetesMIPS CQM · eCQM

MIPS 118Process

Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy - Diabetes or Left Ventricular Systolic Dysfunction (LVEF ≤ 40%)

Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12- month period who also have diabetes OR a current or prior Left Ventricular Ejection Fraction (LVEF) ≤ 40% who were prescribed ACE inhibitor or ARB therapy.

Topped outCardiologyMIPS CQM

MIPS 134Process

Preventive Care and Screening: Screening for Depression and Follow-Up Plan

Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter.

Topped outDepressionMIPS CQM · Medicare Part B Claims · eCQM

MIPS 141Outcome – High Priority

Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 20% OR Documentation of a Plan of Care

Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) whose glaucoma treatment has not failed (the most recent IOP was reduced by at least 20% from the pre-intervention level) OR if the most recent IOP was not reduced by at least 20% from the pre-intervention level, a plan of care was documented within the 12 month performance period.

Topped outGlaucomaMIPS CQM · Medicare Part B Claims

MIPS 168Outcome – High Priority

Coronary Artery Bypass Graft (CABG): Surgical Re-Exploration

Percentage of patients aged 18 years and older undergoing isolated coronary artery bypass graft (CABG) surgery who require a return to the operating room (OR) for mediastinal bleeding with or without tamponade, unplanned coronary artery intervention (native vessel, graft or both), valve dysfunction, aortic reintervention or other cardiac reason during the current hospitalization.

BenchmarkCardiac SurgeryMIPS CQM

MIPS 177Process

Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity

Percentage of patients aged 18 years and older with two or more encounters with diagnosis of rheumatoid arthritis (RA) at least 90 days apart who have an assessment of disease activity using an ACR-preferred RA disease activity assessment tool at ≥50% of encounters for RA for each patient during the performance period.

Topped outRheumatologyMIPS CQM

MIPS 180Process

Rheumatoid Arthritis (RA): Glucocorticoid Management

Percentage of patients aged 18 years and older with two or more encounters with a diagnosis of rheumatoid arthritis (RA) at least 90 days apart who have been assessed for glucocorticoid use and, for those on prolonged doses of prednisone >5 mg daily (or equivalent) with improvement or no change in disease activity, documentation of glucocorticoid management plan during the performance period.

Topped outRheumatologyMIPS CQM

MIPS 182Process – High Priority

Functional Outcome Assessment

Percentage of visits for patients aged 18 years and older with documentation of a current functional outcome assessment using a standardized functional outcome assessment tool on the date of the encounter AND documentation of a care plan based on identified functional outcome performance deficits within two days of the date of the identified deficits.

Topped outFunctional AssessmentMIPS CQM

MIPS 191Outcome – High Priority

Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery

Percentage of cataract surgeries for patients aged 18 years and older with a diagnosis of uncomplicated cataract and no significant ocular conditions impacting the visual outcome of surgery and had best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following the cataract surgery.

Topped outOphthalmologyMIPS CQM · eCQM

MIPS 217Patient-Reported Outcome-Based Performance Measure – High Priority

Functional Status Change for Patients with Knee Impairments

A patient-reported outcome measure (PROM) of risk-adjusted change in functional status (FS) for patients 14 years+ with knee impairments. The change in FS is assessed using the FOTO Lower Extremity Physical Function (LEPF) PROM. The measure is adjusted to patient characteristics known to be associated with FS outcomes (risk adjusted) and used as a performance measure at the patient, individual clinician, and clinic levels to assess quality.

BenchmarkRehabilitationMIPS CQM

MIPS 218Patient-Reported Outcome-Based Performance Measure – High Priority

Functional Status Change for Patients with Hip Impairments

A patient-reported outcome measure (PROM) of risk-adjusted change in functional status (FS) for patients 14 years+ with hip impairments. The change in FS is assessed using the FOTO Lower Extremity Physical Function (LEPF) PROM. The measure is adjusted to patient characteristics known to be associated with FS outcomes (risk adjusted) and used as a performance measure at the patient, individual clinician, and clinic levels to assess quality.

BenchmarkRehabilitationMIPS CQM

MIPS 219Patient-Reported Outcome-Based Performance Measure – High Priority

Functional Status Change for Patients with Lower Leg, Foot or Ankle Impairments

A patient-reported outcome measure (PROM) of risk-adjusted change in functional status (FS) for patients 14 years+ with foot, ankle or lower leg impairments. The change in FS is assessed using the FOTO Lower Extremity Physical Function (LEPF) PROM. The measure is adjusted to patient characteristics known to be associated with FS outcomes (risk adjusted) and used as a performance measure at the patient, individual clinician, and clinic levels to assess quality.

BenchmarkRehabilitationMIPS CQM

MIPS 220Patient-Reported Outcome-Based Performance Measure – High Priority

Functional Status Change for Patients with Low Back Impairments

A patient-reported outcome measure (PROM) of risk-adjusted change in functional status (FS) for patients 14 years+ with low back impairments. The change in FS is assessed using the FOTO Low Back FS PROM. The measure is adjusted to patient characteristics known to be associated with FS outcomes (risk adjusted) and used as a performance measure at the patient, individual clinician, and clinic levels to assess quality.

BenchmarkRehabilitationMIPS CQM

MIPS 221Patient-Reported Outcome-Based Performance Measure – High Priority

Functional Status Change for Patients with Shoulder Impairments

A patient-reported outcome measure (PROM) of risk-adjusted change in functional status (FS) for patients 14 years+ with shoulder impairments. The change in FS is assessed using the FOTO Shoulder FS PROM. The measure is adjusted to patient characteristics known to be associated with FS outcomes (risk adjusted) and used as a performance measure at the patient, individual clinician, and clinic levels to assess quality.

BenchmarkRehabilitationMIPS CQM

MIPS 222Patient-Reported Outcome-Based Performance Measure – High Priority

Functional Status Change for Patients with Elbow, Wrist or Hand Impairments

A patient-reported outcome measure (PROM) of risk-adjusted change in functional status (FS) for patients 14 years+ with elbow, wrist, or hand impairments. The change in FS is assessed using the FOTO Elbow/Wrist/Hand FS PROM. The measure is adjusted to patient characteristics known to be associated with FS outcomes (risk adjusted) and used as a performance measure at the patient, individual clinician, and clinic levels to assess quality.

BenchmarkRehabilitationMIPS CQM

MIPS 226Process

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Percentage of patients aged 12 years and older who were screened for tobacco use one or more times within the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user.

Topped outPreventive CareMIPS CQM · Medicare Part B Claims · eCQM

MIPS 236Intermediate Outcome – High Priority

Controlling High Blood Pressure

Percentage of patients 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (< 140/90mmHg) during the measurement period.

BenchmarkHypertensionMIPS CQM · Medicare Part B Claims · eCQM

MIPS 243Process - High Priority

Cardiac Rehabilitation Patient Referral from an Outpatient Setting

Percentage of patients evaluated in an outpatient setting who within the previous 12 months have experienced an acute myocardial infarction (MI), coronary artery bypass graft (CABG) surgery, a percutaneous coronary intervention (PCI), cardiac valve surgery, or cardiac transplantation, or who have chronic stable angina (CSA) and have not already participated in an early outpatient cardiac rehabilitation/secondary prevention (CR) program for the qualifying event/diagnosis who were referred to a CR program.

BenchmarkCardiac RehabilitationMIPS CQM

MIPS 259Outcome – High Priority

Rate of Endovascular Aneurysm Repair (EVAR) of Small or Moderate Non-Ruptured Infrarenal Abdominal Aortic Aneurysms (AAA) without Major Complications (Discharged to Home by Post-Operative Day #2)

Percent of patients undergoing endovascular repair of small or moderate non-ruptured infrarenal abdominal aortic aneurysms (AAA) that do not experience a major complication (discharged to home no later than post-operative day #2).

BenchmarkVascular SurgeryMIPS CQM

MIPS 261Process – High Priority

Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness

Percentage of patients aged birth and older referred to a physician (preferably a physician specially trained in disorders of the ear) for an otologic evaluation subsequent to an audiologic evaluation after presenting with acute or chronic dizziness.

BenchmarkOtolaryngologyMIPS CQM · Medicare Part B Claims

MIPS 277Process

Sleep Apnea: Severity Assessment at Initial Diagnosis

Percentage of patients aged 18 years and older with a diagnosis of obstructive sleep apnea who had an apnea hypopnea index (AHI), a respiratory disturbance index (RDI), or a respiratory event index (REI) documented or measured within 2 months after initial evaluation for suspected obstructive sleep apnea.

Topped outSleep MedicineMIPS CQM

MIPS 279Process

Sleep Apnea: Assessment of Adherence to Obstructive Sleep Apnea (OSA) Therapy

Percentage of patients aged 18 years and older with a diagnosis of obstructive sleep apnea (OSA) that were prescribed an evidence-based therapy that had documentation that adherence to therapy was assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available).

Topped outSleep MedicineMIPS CQM

MIPS 286Process – High Priority

Dementia: Safety Concern Screening and Follow-Up for Patients with Dementia

Percentage of patients with dementia or their caregiver(s) for whom there was a documented safety concerns screening in two domains of risk: 1) dangerousness to self or others and 2) environmental risks; and if safety concerns screening was positive in the last 12 months, there was documentation of mitigation recommendations, including but not limited to referral to other resources.

Topped outDementiaMIPS CQM

MIPS 303Patient-Reported Outcome-Based Performance Measure – High Priority

Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract

Percentage of patients aged 18 years and older who had cataract surgery and had improvement in visual function achieved within 90 days following the cataract surgery, based on completing a pre-operative and post-operative visual function survey.

BenchmarkOphthalmologyMIPS CQM

MIPS 304Patient Engagement / Experience – High Priority

Cataracts: Patient Satisfaction within 90 Days Following Cataract Surgery

Percentage of patients aged 18 years and older who had cataract surgery and were satisfied with their care within 90 days following the cataract surgery, based on completion of the Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey.

BenchmarkOphthalmologyMIPS CQM

MIPS 317Process

Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

Percentage of patient visits for patients aged 18 years and older seen during the performance period who were screened for high blood pressure AND a recommended follow-up plan is documented, as indicated, if blood pressure is elevated or hypertensive.

Topped outHypertensionMIPS CQM · Medicare Part B Claims · eCQM

MIPS 320Process – High Priority

Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients

Percentage of patients aged 45 to 75 years of age receiving a screening colonoscopy without biopsy or polypectomy who had a recommended follow-up interval of 10 years for repeat colonoscopy documented in their colonoscopy report.

Topped outColorectal CancerMIPS CQM · Medicare Part B Claims

MIPS 332Process – High Priority

Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin With or Without Clavulanate Prescribed for Patients with Acute Bacterial Sinusitis (Appropriate Use)

Percentage of patients aged 18 years and older with a diagnosis of acute bacterial sinusitis that were prescribed amoxicillin, with or without clavulanate, as a first line antibiotic at the time of diagnosis.

Topped outOtolaryngologyMIPS CQM

MIPS 336Process – High Priority

Maternity Care: Postpartum Follow-up and Care Coordination

Percentage of patients, regardless of age, who gave birth during a 12-month period who were seen for postpartum care before or at 12 weeks of giving birth and received the following at a postpartum visit: breastfeeding evaluation and education, postpartum depression screening, intimate partner violence screening, postpartum glucose screening for gestational diabetes patients, family and contraceptive planning counseling, tobacco use screening and cessation education, healthy lifestyle behavioral advice, and an immunization review and update.

BenchmarkEndocrinologyMIPS CQM

MIPS 340Process – High Priority

HIV Annual Retention in Care

Percentage of patients, regardless of age, with a diagnosis of Human Immunodeficiency Virus (HIV) before or during the first 240 days of the performance period who had at least two eligible encounters or at least one eligible encounter and one HIV viral load test that were at least 90 days apart within the performance period.

BenchmarkHIVMIPS CQM · eCQM

MIPS 344Outcome – High Priority

Rate of Carotid Endarterectomy (CEA) or Carotid Artery Stenting (CAS) for Asymptomatic Patients, Without Major Complications (Discharged to Home by Post-Operative Day #2)

Percent of asymptomatic patients undergoing Carotid Endarterectomy (CEA) or Carotid Artery Stenting (CAS) without major complication who are discharged to home no later than post-operative day #2.

BenchmarkVascular SurgeryMIPS CQM

MIPS 350Process – High Priority

Total Knee or Hip Replacement: Shared Decision-Making: Trial of Conservative (Non-surgical) Therapy

Percentage of patients regardless of age undergoing a total knee or total hip replacement with documented shared decision-making with discussion of conservative (non-surgical) therapy (e.g., non-steroidal anti-inflammatory drug (NSAIDs), analgesics, weight loss, exercise, injections) prior to the procedure.

Topped outOrthopedicsMIPS CQM

MIPS 351Process – High Priority

Total Knee or Hip Replacement: Venous Thromboembolic and Cardiovascular Risk Evaluation

Percentage of patients regardless of age undergoing a total knee or total hip replacement who are evaluated for the presence or absence of venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., History of Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), Myocardial Infarction (MI), Arrhythmia and Stroke).

Topped outOrthopedicsMIPS CQM

MIPS 358Process – High Priority

Patient-Centered Surgical Risk Assessment and Communication

Percentage of patients who underwent a non-emergency surgery who had their personalized risks of postoperative complications assessed by their surgical team prior to surgery using a clinical data-based, patient-specific risk calculator and who received personal discussion of those risks with the surgeon.

Topped outShared Decision-MakingMIPS CQM

MIPS 360Process – High Priority

Optimizing Patient Exposure to Ionizing Radiation: Count of Potential High Dose Radiation Imaging Studies: Computed Tomography (CT) and Cardiac Nuclear Medicine Studies

Percentage of computed tomography (CT) and cardiac nuclear medicine (myocardial perfusion or infarct avid imaging) reports for all patients, regardless of age, that document a count of known previous CT (any type of CT) and cardiac nuclear medicine (myocardial perfusion or infarct avid imaging) studies that the patient has received in the 12-month period prior to the current study.

Topped outAppropriate UseMIPS CQM

MIPS 364Process – High Priority

Optimizing Patient Exposure to Ionizing Radiation: Appropriateness: Follow-up CT Imaging for Incidentally Detected Pulmonary Nodules According to Recommended Guidelines

Percentage of final reports for CT imaging studies with a finding of an incidental pulmonary nodule for patients aged 35 years and older that contain an impression or conclusion that includes a recommended interval and modality for follow- up (e.g., type of imaging or biopsy) or for no follow-up, and source of recommendations (e.g., guidelines such as Fleischner Society, American Lung Association, American College of Chest Physicians).

Topped outAppropriate UseMIPS CQM

MIPS 383Intermediate Outcome – High Priority

Adherence to Antipsychotic Medications For Individuals with Schizophrenia

Percentage of individuals at least 18 years of age as of the beginning of the performance period with schizophrenia or schizoaffective disorder who had at least two prescriptions filled for any antipsychotic medication and who had a Proportion of Days Covered (PDC) of at least 0.8 for antipsychotic medications during the performance period.

BenchmarkMedication AdherenceMIPS CQM

MIPS 386Process – High Priority

Amyotrophic Lateral Sclerosis (ALS) Patient Care Preferences

Percentage of patients diagnosed with Amyotrophic Lateral Sclerosis (ALS) who were offered assistance in planning for end of life issues (e.g., advance directives, invasive ventilation, lawful physician-hastened death, or hospice) or whose existing end of life plan was reviewed or updated at least once annually or more frequently as clinically indicated (i.e., rapid progression).

BenchmarkAdvance Care PlanningMIPS CQM

MIPS 392Outcome – High Priority

Cardiac Tamponade and/or Pericardiocentesis Following Atrial Fibrillation Ablation

Rate of cardiac tamponade and/or pericardiocentesis following atrial fibrillation ablation. This measure is submitted as four rates stratified by age and gender: • Submission Age Criteria 1: Females 18-64 years of age • Submission Age Criteria 2: Males 18-64 years of age • Submission Age Criteria 3: Females 65 years of age and older • Submission Age Criteria 4: Males 65 years of age and older

BenchmarkCardiac ElectrophysiologyMIPS CQM

MIPS 395Process – High Priority

Lung Cancer Reporting (Biopsy/Cytology Specimens)

Pathology reports based on lung biopsy and/or cytology specimens with a diagnosis of primary non-small cell lung cancer classified into specific histologic type following the International Association for the Study of Lung Cancer (IASLC) guidance or classified as non-small cell lung cancer not otherwise specified (NSCLC-NOS) with an explanation included in the pathology report.

Topped outOncologyMIPS CQM · Medicare Part B Claims

MIPS 400Process

One-Time Screening for Hepatitis C Virus (HCV) and Treatment Initiation

Percentage of patients aged ≥ 18 years who have never been tested for Hepatitis C Virus (HCV) infection who receive an HCV infection test AND who have treatment initiated within three months or who are referred to a clinician who treats HCV infection within one month if tested positive for HCV.

BenchmarkHepatologyMIPS CQM

MIPS 405Process – High Priority

Appropriate Follow-up Imaging for Incidental Abdominal Lesions

Percentage of final reports for imaging studies for patients aged 18 years and older with one or more of the following noted incidentally with a specific recommendation for no follow‐up imaging recommended based on radiological findings: • Cystic renal lesion that is simple appearing* (Bosniak I or II) • Adrenal lesion less than or equal to 1.0 cm • Adrenal lesion greater than 1.0 cm but less than or equal to 4.0 cm classified as likely benign or diagnostic benign by unenhanced CT or washout protocol CT, or MRI with in- and opposed-phase sequences or other equivalent institutional imaging protocols

Topped outImagingMIPS CQM · Medicare Part B Claims

MIPS 406Process – High Priority

Appropriate Follow-up Imaging for Incidental Thyroid Nodules in Patients

Percentage of final reports for computed tomography (CT), CT angiography (CTA) or magnetic resonance imaging (MRI) or magnetic resonance angiogram (MRA) studies of the chest or neck for patients aged 18 years and older with no known thyroid disease with a thyroid nodule < 1.0 cm noted incidentally with follow-up imaging recommended.

Topped outAppropriate UseMIPS CQM · Medicare Part B Claims

MIPS 410Intermediate Outcome – High Priority

Psoriasis: Clinical Response to Systemic Medications

Percentage of psoriasis vulgaris patients receiving systemic medication who meet minimal physician-or patient- reported disease activity levels. It is implied that establishment and maintenance of an established minimum level of disease control as measured by physician-and/or patient-reported outcomes will increase patient satisfaction with and adherence to treatment.

BenchmarkDermatologyMIPS CQM

MIPS 415Efficiency – High Priority

Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients Aged 18 Years and Older

Percentage of emergency department visits for patients aged 18 years and older who presented with a minor blunt head trauma who had a head CT for trauma ordered by an emergency care provider who have an indication for a head CT.

Topped outEmergency MedicineMIPS CQM

MIPS 416Efficiency – High Priority

Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients Aged 2 Through 17 Years

Percentage of emergency department visits for patients aged 2 through 17 years who presented with a minor blunt head trauma who had a head CT for trauma ordered by an emergency care provider who are classified as low risk according to the Pediatric Emergency Care Applied Research Network (PECARN) prediction rules for traumatic brain injury.

BenchmarkEmergency MedicineMIPS CQM

MIPS 420Patient Reported Outcome-Based Performance Measure – High Priority

Varicose Vein Treatment with Saphenous Ablation: Outcome Survey

Percentage of patients treated for varicose veins (CEAP C2-S) who are treated with saphenous ablation (with or without adjunctive tributary treatment) that report an improvement on a disease specific patient reported outcome survey instrument after treatment.

BenchmarkVascular DiseaseMIPS CQM

MIPS 430Process – High Priority

Prevention of Post-Operative Nausea and Vomiting (PONV) – Combination Therapy

Percentage of patients, aged 18 years and older, who undergo a procedure under an inhalational general anesthetic, AND who have three or more risk factors for post-operative nausea and vomiting (PONV), who receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively.

Topped outAnesthesiologyMIPS CQM

MIPS 438Process

Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the performance period: • All patients who were previously diagnosed with or currently have a diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD), including an ASCVD procedure; OR • Patients aged 20 to 75 years who have ever had a low-density lipoprotein cholesterol (LDL-C) level ≥ 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia; OR • Patients aged 40 to 75 years with a diagnosis of diabetes; OR • Patients aged 40 to 75 with a 10-year ASCVD risk score of ≥ 20 percent.

BenchmarkCardiologyMIPS CQM · eCQM

MIPS 440Process – High Priority

Skin Cancer: Biopsy Reporting Time – Pathologist to Clinician

Percentage of biopsies with a diagnosis of cutaneous basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), or melanoma (including in situ disease) in which the pathologist communicates results to the clinician within 7 days from the time when the tissue specimen was received by the pathologist.

Topped outDermatologyMIPS CQM

MIPS 441Intermediate Outcome – High Priority

Ischemic Vascular Disease (IVD) All or None Outcome Measure (Optimal Control)

The IVD All-or-None Measure is one outcome measure (optimal control). The measure contains four goals. All four goals within a measure must be reached in order to meet that measure. The numerator for the all-or-none measure should be collected from the organization's total IVD denominator. All-or-None Outcome Measure (Optimal Control) - Using the IVD denominator optimal results include: • Most recent blood pressure (BP) measurement is less than or equal to 130/80 mm Hg -- AND • Most recent tobacco status is Tobacco Free -- AND • Daily Aspirin or Other Antiplatelet Unless Contraindicated – AND • High Intensity Statin Use Unless Contraindicated

BenchmarkCardiologyMIPS CQM

MIPS 445Outcome – High Priority

Risk-Adjusted Operative Mortality for Coronary Artery Bypass Graft (CABG)

Percent of patients aged 18 years and older undergoing isolated coronary artery bypass graft (CABG) who die, including both all deaths occurring during the hospitalization in which the CABG was performed, even if after 30 days, and those deaths occurring after discharge from the hospital, but within 30 days of the procedure.

BenchmarkCardiac SurgeryMIPS CQM

MIPS 451Process

RAS (KRAS and NRAS) Gene Mutation Testing Performed for Patients with Metastatic Colorectal Cancer who Receive Anti-epidermal Growth Factor Receptor (EGFR) Monoclonal Antibody Therapy

Percentage of adult patients (aged 18 or over) with metastatic colorectal cancer who receive anti-epidermal growth factor receptor (EGFR) monoclonal antibody (MoAb) therapy for whom RAS (KRAS and NRAS) gene mutation testing was performed before initiation of anti-EGFR MoAb.

BenchmarkColorectal CancerMIPS CQM

MIPS 459Patient-Reported Outcome-Based Performance Measure – High Priority

Back Pain After Lumbar Surgery

For patients 18 years of age or older who had a lumbar discectomy/laminectomy or fusion procedure, back pain is rated by the patients as less than or equal to 3.0 OR an improvement of 5.0 points or greater on the Visual Analog Scale (VAS) Pain scale or a numeric pain scale at three months (6 to 20 weeks) postoperatively for discectomy/laminectomy or at one year (9 to 15 months) postoperatively for lumbar fusion patients. Rates are stratified by procedure type; lumbar discectomy/laminectomy or fusion procedure.

BenchmarkOrthopedicsMIPS CQM

MIPS 461Patient-Reported Outcome-Based Performance Measure – High Priority

Leg Pain After Lumbar Surgery

For patients 18 years of age or older who had a lumbar discectomy/laminectomy or fusion procedure, leg pain is rated by the patient as less than or equal to 3.0 OR an improvement of 5.0 points or greater on the Visual Analog Scale (VAS) Pain scale or a numeric pain scale at three months (6 to 20 weeks) for discectomy/laminectomy or at one year (9 to 15 months) postoperatively for lumbar fusion patients. Rates are stratified by procedure type; lumbar discectomy/laminectomy or fusion procedure.

BenchmarkOrthopedicsMIPS CQM

MIPS 463Process – High Priority

Prevention of Post-Operative Vomiting (POV) – Combination Therapy (Pediatrics)

Percentage of patients aged 3 through 17 years, who undergo a procedure under general anesthesia in which an inhalational anesthetic is used for maintenance AND who have two or more risk factors for post-operative vomiting (POV), who receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively.

Topped outAnesthesiologyMIPS CQM

MIPS 470Patient-Reported Outcome-Based Performance Measure – High Priority

Functional Status After Primary Total Knee Replacement

For patients age 18 and older who had a primary total knee replacement procedure, functional status is rated by the patient as greater than or equal to 37 on the Oxford Knee Score (OKS) or a 71 or greater on the KOOS, JR. tool at one year (9 to 15 months) postoperatively.

BenchmarkOrthopedicsMIPS CQM

MIPS 471Patient-Reported Outcome-Based Performance Measure – High Priority

Functional Status After Lumbar Surgery

For patients age 18 and older who had lumbar discectomy/laminectomy or fusion procedure, functional status is rated by the patient as less than or equal to 22 OR an improvement of 30 points or greater on the Oswestry Disability Index (ODI version 2.1a) * at three months (6 to 20 weeks) postoperatively for discectomy/laminectomy or at one year (9 to 15 months) postoperatively for lumbar fusion patients. Rates are stratified by procedure type; lumbar discectomy/laminectomy or fusion procedure. * hereafter referred to as ODI

BenchmarkOrthopedicsMIPS CQM

MIPS 478Patient-Reported Outcome-Based Performance Measure – High Priority

Functional Status Change for Patients with Neck Impairments

A patient-reported outcome measure (PROM) of risk-adjusted change in functional status (FS) for patients 14 years+ with neck impairments. The change in FS is assessed using the FOTO Neck FS PROM. The measure is adjusted to patient characteristics known to be associated with FS outcomes (risk-adjusted) and used as a performance measure at the patient, individual clinician, and clinic levels to assess quality.

BenchmarkNeurologyMIPS CQM

MIPS 483Patient-Reported Outcome-Based Performance Measure – High Priority

Person-Centered Primary Care Measure Patient Reported Outcome Performance Measure (PCPCM PRO-PM)

The Person-Centered Primary Care Measure Patient Reported Outcome Performance Measure (PCPCM PRO-PM) uses the PCPCM Patient Reported Outcome Measure (PROM) a comprehensive and parsimonious set of 11 patient-reported items - to assess the broad scope of primary care. Unlike other primary care measures, the PCPCM PRO-PM measures the high value aspects of primary care based on a patient’s relationship with the clinician or practice.

BenchmarkPrimary CareMIPS CQM

MIPS 485Patient-Reported Outcome-based Performance Measure – High Priority

Psoriasis – Improvement in Patient-Reported Itch Severity

The percentage of patients aged 8 years and older, with a diagnosis of psoriasis where at an initial (index) visit have a patient-reported itch severity assessment performed, score greater than or equal to 4, and who achieve a score reduction of 3 or more points at a follow-up visit.

BenchmarkDermatologyMIPS CQM

MIPS 486Patient-Reported Outcome-based Performance Measure – High Priority

Dermatitis – Improvement in Patient-Reported Itch Severity

The percentage of patients aged 8 years and older, with a diagnosis of dermatitis where at an initial (index) visit have a patient-reported itch severity assessment performed, score greater than or equal to 4, and who achieve a score reduction of 3 or more points at a follow-up visit.

BenchmarkDermatologyMIPS CQM

MIPS 489Process

Adult Kidney Disease: Angiotensin Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy

Percentage of patients aged 18 years and older with a diagnosis of chronic kidney disease (CKD) (Stages 1-5, not receiving Renal Replacement Therapy (RRT)) and proteinuria who were prescribed ACE inhibitor or ARB therapy within a 12-month period.

Topped outNephrologyMIPS CQM

MIPS 490Process

Appropriate Intervention of Immune-Related Diarrhea and/or Colitis in Patients Treated

Percentage of patients aged 18 years and older, with a diagnosis of cancer, on immune checkpoint inhibitor therapy, and grade 2 or above diarrhea and/or grade 2 or above colitis, who have immune checkpoint inhibitor therapy held and corticosteroids or immunosuppressants prescribed or administered.

BenchmarkOncologyMIPS CQM

MIPS 491Process – High Priority

Mismatch Repair (MMR) or Microsatellite Instability (MSI) Biomarker Testing Status

Percentage of surgical pathology reports for primary colorectal, endometrial, gastroesophageal or small bowel carcinoma, biopsy or resection, that contain impression or conclusion of or recommendation for testing of mismatch repair (MMR) by immunohistochemistry (biomarkers MLH1, MSH2, MSH6, and PMS2), or microsatellite instability (MSI) by DNA-based testing status, or both.

Topped outOncologyMIPS CQM

MIPS 495Patient-Reported Outcome-Based Performance Measure (PRO-PM) – High Priority

Ambulatory Palliative Care Patients’ Experience of Feeling Heard and Understood

The percentage of top-box responses among patients aged 18 years and older who had an ambulatory palliative care visit and report feeling heard and understood by their palliative care clinician and team within 2 months (60 days) of the ambulatory palliative care visit.

BenchmarkPalliative CareMIPS CQM

MIPS 497Process

Preventive Care and Wellness (Composite)

Percentage of patients who received age-and sex-appropriate preventive screenings and wellness services. This measure is a composite of seven component measures that are based on recommendations for preventive care by the U.S. Preventive Services Task Force (USPSTF), Advisory Committee on Immunization Practices (ACIP), American Association of Clinical Endocrinology (AACE), and American College of Endocrinology (ACE).

BenchmarkPreventive CareMIPS CQM

MIPS 499Process

Appropriate Screening and Plan of Care for Elevated Intraocular Pressure Following Intravitreal or Periocular Steroid Therapy

Percentage of patients who had an intravitreal or periocular corticosteroid injection (e.g., triamcinolone, preservative-free triamcinolone, dexamethasone, dexamethasone intravitreal implant, or fluocinolone intravitreal implant) who, within seven (7) weeks following the date of injection, are screened for elevated intraocular pressure (IOP) with tonometry with documented IOP ≤ 25 mm Hg for injected eye OR if the IOP was > 25 mm Hg, a plan of care was documented.

BenchmarkOphthalmologyMIPS CQM

MIPS 502Patient-Reported Outcome-based Performance Measure (PRO-PM) – High Priority

Improvement or Maintenance of Functioning for Individuals with a Mental and/or Substance Use Disorder

The percentage of patients aged 18 and older with a mental and/or substance use disorder who demonstrated improvement or maintenance of functioning based on results from the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) or Sheehan Disability Scale (SDS) 30 to 180 days after an index assessment.

BenchmarkMental HealthMIPS CQM

MIPS 503Patient-Reported Outcome-Based Measure (PRO-PM) – High Priority

Gains in Patient Activation Measure (PAM) Scores at 12 Months

The Patient Activation Measure® (PAM®) is a 10- or 13-item questionnaire that assesses an individual´s knowledge, skills, and confidence for managing their health and health care. The measure assesses individuals on a 0-100 scale that converts to one of four levels of activation, from low (1) to high (4). The PAM® performance measure (PAM®-PM) is the change in score on the PAM® from baseline to follow-up measurement.

BenchmarkCare CoordinationMIPS CQM

MIPS 504Process – High Priority

Initiation, Review, and/or Update to Suicide Safety Plan for Individuals with Suicidal

Percentage of patients aged 12 years and older with suicidal ideation or behavior symptoms (based on results of a standardized assessment tool or screening tool) or increased suicide risk (based on the clinician's evaluation or clinician- rating tool) for whom a suicide safety plan is initiated, reviewed, and/or updated in collaboration between the patient and their clinician.

BenchmarkSuicide PreventionMIPS CQM

MIPS 505Patient-Reported Outcome-Based Performance Measure (PRO-PM) – High Priority

Reduction in Suicidal Ideation or Behavior Symptoms

The percentage of patients aged 18 years and older with a mental and/or substance use disorder AND suicidal thoughts, behaviors or risk symptoms who demonstrated a reduction in suicidal ideation and/or behavior symptoms based on results from the Columbia-Suicide Severity Rating Scale 'Screen Version' or 'Since Last Visit' (C-SSRS), within 120 days after an index assessment.

BenchmarkSuicide PreventionMIPS CQM

MIPS 506Process – High Priority

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

Percentage of patients aged 18 years and older with a diagnosis of metastatic non-small cell lung cancer (NSCLC) or squamous cell carcinoma of head and neck (HNSCC) on first-line immune checkpoint inhibitor (ICI) therapy, who had a positive PD-L1 biomarker expression test result prior to giving ICI therapy.

BenchmarkOncologyMIPS CQM

MIPS 510Process

First Year Standardized Kidney Transplant Waitlist Ratio (FYSWR)

The number of newly initiated patients on dialysis in a practitioner group who are under the age of 75 and were either listed on the kidney or kidney-pancreas transplant waitlist or received a living donor transplant within the first year of initiating dialysis. The practitioner group is inclusive of physicians and advanced practice providers. The measure is the ratio-observed number of waitlist events in a practitioner group to its expected number of waitlist events. The measure uses the expected waitlist events calculated from a Cox model, which is adjusted for age, patient comorbidities, and other risk factors at the time of dialysis.

BenchmarkNephrologyMIPS CQM

MIPS 511Process

Percentage of Prevalent Patients Waitlisted for Kidney Transplant (PPPW) and Percentage of Prevalent Patients Waitlisted for Kidney Transplant in Active Status (aPPPW)

The measure tracks dialysis patients who are under the age of 75 in a practitioner group and on the kidney or kidney- pancreas transplant waitlist (all patients or patients in active status). This measure is a risk-adjusted percentage of waitlist events among dialysis patients.

BenchmarkNephrologyMIPS CQM

MIPS 512Process

Prevalent Standardized Kidney Transplant Waitlist Ratio (PSWR)

The number of prevalent dialysis patients in a practitioner group who are under the age of 75 and were listed on the kidney or kidney-pancreas transplant waitlist or received a living donor transplant. The practitioner group is inclusive of physicians and advanced practice providers. The measure is the ratio-observed number of waitlist events in a practitioner group to its expected number of waitlist events. The measure uses the expected waitlist events calculated from a Cox model, which is adjusted for age, patient comorbidities, and other risk factors at the time of dialysis.

BenchmarkNephrologyMIPS CQM

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MIPS 001Intermediate Outcome – High PriorityDiabetes: Glycemic Status Assessment Greater Than 9%MIPS CQM · Medicare Part B Claims · eCQMOn this pageMeasure specificationMIPS score simulatorVBCA insightsClinical rationaleBenchmark decilesOpen MIPS 001

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