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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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.

2026 MIPS 065 Benchmarks

Historical CMS benchmark deciles for MIPS quality measure 065 by collection type. Your performance rate falls into a decile, which determines your measure points (3–10).

MIPS CQMAvg. performance rate: 96.20%Topped Out — 7-point cap

Decile	Performance Rate Range	Points
Decile 1	38.75 - 91.79%	1 – 1.9
Decile 2	91.80 - 95.70%	2 – 2.9
Decile 3	95.71 - 97.67%	3 – 3.9
Decile 4	97.68 - 98.88%	4 – 4.9
Decile 5	98.89 - 99.50%	5 – 5.9
Decile 6	99.51 - 99.99%	6 – 6.9
Decile 10	100.00%	10

eCQMAvg. performance rate: 88.61%

Decile	Performance Rate Range	Points
Decile 1	33.33 - 70.91%	1 – 1.9
Decile 2	70.92 - 82.25%	2 – 2.9
Decile 3	82.26 - 87.49%	3 – 3.9
Decile 4	87.50 - 90.70%	4 – 4.9
Decile 5	90.71 - 93.16%	5 – 5.9
Decile 6	93.17 - 95.34%	6 – 6.9
Decile 7	95.35 - 97.15%	7 – 7.9
Decile 8	97.16 - 99.01%	8 – 8.9
Decile 9	99.02 - 99.99%	9 – 9.9
Decile 10	100.00%	10

Specialty Measure Sets

Emergency Medicine Family Medicine Infectious Disease Pediatrics Urgent Care

Related Measures

Appropriate Use

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

Infectious Disease

MIPS 066: Appropriate Testing for Pharyngitis MIPS 176: Tuberculosis Screening Prior to First Course of Biologic and/or Immune Response MIPS 205: Sexually Transmitted Infection (STI) Testing for People with HIV MIPS 338: HIV Viral Suppression MIPS 387: Annual Hepatitis C Virus (HCV) Screening for Patients who are Active Injection Drug Users MIPS 400: One-Time Screening for Hepatitis C Virus (HCV) and Treatment Initiation MIPS 516: Hepatitis C Virus (HCV): Sustained Virological Response (SVR)

Official Resources

📄 CMS Measure Specification (PDF)🔗 QPP Quality Payment Program

Clinical Context

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.

Frequently Asked Questions

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.

Is MIPS 65 the same as MIPS 065?

Yes. CMS uses zero-padded three-digit Quality IDs (065) in official specifications, while clinicians often search for MIPS 65 or Quality ID 65 without the leading zero. Both refer to the same 2026 MIPS quality measure reported through the Quality Payment Program (QPP).

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)

What is the NQF number for MIPS Measure 065?

MIPS Measure 065 is associated with CBE/NQF number 69. It is also identified as eCQM CMS154v14. It can be reported through the Quality Payment Program (QPP) as a MIPS Clinical Quality Measure (CQM).

How do I report MIPS Measure 065 in 2026?

MIPS Measure 065 (Quality ID 65) is reported through the Quality Payment Program (QPP) as a MIPS Clinical Quality Measure (CQM) via qualified registry, eCQM, or Medicare Part B claims where applicable.

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.

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