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

2026 MIPS Measure #065: 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
Measure ID:MIPS 065 (Quality ID 65)
eCQM:CMS154v14
CBE:69
Collection:MIPS CQM, eCQM
Topped Out:Yes
View CMS Spec ↗

Measure Specification

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
Exclusions
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
Reporting Codes

Performance Met:

G8708Patient not prescribed antibiotic

Performance Not Met:

G8710Patient prescribed antibiotic
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.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 065 to the Quality Payment Program (QPP). Practices can report this measure as a MIPS Clinical Quality Measure (CQM), as an eCQM, or through qualified registry submission.

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Related Measures

Appropriate Use
MIPS 066: Appropriate Testing for PharyngitisMIPS 102: Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk ProstateMIPS 116: Avoidance of Antibiotic Treatment for Acute Bronchitis/BronchiolitisMIPS 261: Referral for Otologic Evaluation for Patients with Acute or Chronic DizzinessMIPS 277: Sleep Apnea: Severity Assessment at Initial DiagnosisMIPS 331: Adult Sinusitis: Antibiotic Prescribed for Acute Viral Sinusitis (Overuse)MIPS 332: Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin With or Without ClavulanateMIPS 335: Maternity Care: Elective Delivery (Without Medical Indication) at < 39 Weeks (Overuse)MIPS 360: Optimizing Patient Exposure to Ionizing Radiation: Count of Potential High DoseMIPS 364: Optimizing Patient Exposure to Ionizing Radiation: Appropriateness: Follow-up CTMIPS 405: Appropriate Follow-up Imaging for Incidental Abdominal LesionsMIPS 406: Appropriate Follow-up Imaging for Incidental Thyroid Nodules in PatientsMIPS 416: Emergency Medicine: Emergency Department Utilization of CT for Minor BluntMIPS 421: Appropriate Assessment of Retrievable Inferior Vena Cava (IVC) Filters for Removal

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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