Who is eligible for MIPS 065?

Outpatient visits, telephone visits, online assessments (i.e., e-visit or virtual check-in), observation stays or emergency department visits with a diagnosis of upper respiratory infection (URI) from January 1 to December 28 for patients 3 months of age and older. Denominator Instructions: This is an episode of care measure that examines all eligible episodes for the patient. If the patient has more than one episode in a 31-day period, include only the first episode. An episode is defined as each eligible encounter for patients aged 3 months of age and older with a diagnosis of upper respiratory infection during the measurement period of January 1 to December 28.

What codes do I submit for MIPS 065: Appropriate Treatment for Upper Respiratory Infection (URI)?

Submission codes: G8708 (Patient not prescribed antibiotic); G8710 (Patient prescribed antibiotic)

Is MIPS 065 a topped-out measure?

Yes, MIPS 065 is currently topped out, which means most clinicians perform well on this measure and it may be subject to a 7-point scoring cap.

Measure ID: MIPS 065|Appropriate Use|2026 Performance Year

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.

Process – High PriorityAppropriate UseInfectious Disease

Last updated: January 15, 2026

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Measure Specification

Denominator (Eligible Population)

Patients aged 3 months of age and older on date of encounter

ANDDiagnosis for URI

ANDPatient encounter during the measurement period

WITHOUTPlace of Service (POS): 21

Denominator Exclusions4

G2173URI episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease)

G2174URI episodes where the patient is taking antibiotics (Table 1) in the 30 days prior to the episode date

G8709URI episodes when the patient had competing diagnoses on or three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, Lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or UTI, and acne)

G9700Patients who use hospice services any time during the measurement period: G9700

Numerator

URI episodes without a prescription for antibiotic medication (Table 1) on or within 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection

Submission Codes (QDCs)

✓ Performance Met

G8708Patient not prescribed antibiotic

✗ Performance Not Met

G8710Patient prescribed antibiotic

Denominator Exceptions

None — this measure has no denominator exceptions.

🧮MIPS Score Simulator

Estimate only — actual CMS scoring may vary based on reporting method, data completeness, and annual rule updates.

Your Performance Rate:%Benchmarks vary by collection type

💡 Tip: Enter your performance rate to compare MIPS points across all collection types. The same rate can score differently depending on how you submit.

VBCA Insights

💡Why This Measure Matters

This measure flags unnecessary antibiotic prescriptions for common colds, which are viral and don't benefit from antibiotics. Inappropriate antibiotics drive antibiotic resistance, a major public health threat that makes infections harder to treat. Educate patients that colds resolve on their own; suggest supportive care instead. Reserve antibiotics for bacterial infections with supporting evidence. Declining to prescribe when not indicated is one of the most important things you can do.

📖Clinical Rationale

Most upper respiratory infections (URI), also known as the common cold, are caused by viruses that require no antibiotic treatment. Too often, antibiotics are prescribed inappropriately, which can lead to antibiotic resistance (when antibiotics can no longer cure bacterial infections). In the United States, at least 2.8 million antibiotic-resistant illnesses and 35,000 deaths occur each year.

📝Clinical Recommendations

American Family Physician (Fashner, Ericson, and Werner, 2012) - Antibiotics should not be used for the treatment of cold symptoms in children or adults. (A) - Nonsteroidal anti-inflammatory drugs reduce pain secondary to upper respiratory tract infection in adults. (A) - Decongestants, antihistamine/decongestant combinations, and intranasal ipratropium (Atrovent) may improve cold symptoms in adults.

(B) Institute for Clinical Systems Improvement (Short, et al., 2017) -The ICSI work group does not recommend antibiotics for treatment of common cold symptoms in children and adults.

📋Implementation Notes

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this episode measure is submitted once for each occurrence of a particular illness or condition during the performance period.

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Appropriate Treatment for Upper Respiratory Infection (URI)

Measure Specification

Denominator (Eligible Population)

Denominator Exclusions4

Numerator

Submission Codes (QDCs)

Denominator Exceptions

🧮MIPS Score Simulator

💡Why This Measure Matters

📖Clinical Rationale

📝Clinical Recommendations

📋Implementation Notes

Measure Details

Specialty Sets

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Official Resources

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