Who is eligible for MIPS 066?

Outpatient, telephone, online assessment (i.e., e-visit or virtual check-in), observation, or emergency department (ED) visits with a diagnosis of pharyngitis or tonsilitis from January 1 to December 28 and an antibiotic order on or within 3 days after the episode date among patients 3 years or older. Denominator Instructions: This is an episode of care measure that examines all eligible episodes for the patient. The intent is to determine whether antibiotics are being ordered appropriately. Antibiotics should only be ordered if a strep test has been performed to confirm a bacterial infection. Antibiotics should not be ordered for viral infections. Antibiotics should be ordered on the episode date through three days after the episode date. An episode is defined as each eligible encounter for patients aged 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order during the measurement period of January 1 to December 28. If a patient has more than one eligible episode in a 31-day period, include only the first eligible episode.

What codes do I submit for MIPS 066: Appropriate Testing for Pharyngitis?

Submission codes: 3210F (Group A Strep Test Performed); 3210F with 8P (Group A Strep Test not Performed, reason not otherwise specified)

Is MIPS 066 a topped-out measure?

Yes, MIPS 066 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 066|Appropriate Use|2026 Performance Year

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.

Process – High PriorityAppropriate UseInfectious Disease

Last updated: January 15, 2026

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Measure Specification

Denominator (Eligible Population)

Patients 3 years of age or older on date of encounter

ANDDiagnosis for pharyngitis or tonsillitis

ANDPatient encounter during the measurement period

WITHOUTPlace of Service (POS): 21

ANDPrescribed antibiotic on or within 3 days after the episode date (Table 1): G8711

Denominator Exclusions4

G9703Episodes where the patient is taking antibiotics (Table 1) in the 30 days prior to the episode date

G2175Episodes 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)

G2097Episodes where the patient had a competing diagnosis on or within three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, Lyme disease, otitis media, acute sinusitis, chronic sinusitis, infection of the 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)

G9702Patients who use hospice services any time during the measurement period: G9702 Reference Medication Table: Table 1 - Denominator Exclusion for Taking Antibiotics [G9703] is defined by the following antibiotic medications only: Note: This list should be used when assessing antibiotic prescriptions for the denominator and denominator exclusion components. Description Prescription Aminopenicillins • Amoxicillin • Ampicillin Beta-lactamase inhibitors • Amoxicillin-clavulanate First generation cephalosporins • Cefadroxi • Cefazolin • Cephalexin Folate antagonist • Trimethoprim Lincomycin derivatives • Clindamycin Macrolides • Azithromycin • Clarithromycin • Erythromycin Natural penicillins • Penicillin G potassium • Penicillin G sodium • Penicillin V potassium • Penicillin G benzathine Quinolones • Ciprofloxacin • Levofloxacin • Moxifloxacin • Ofloxacin Second generation cephalosporins • Cefaclor • Cefprozil • Cefuroxime Sulfonamides • Sulfamethoxazole- trimethoprim Tetracyclines • Doxycycline • Minocycline • Tetracycline Third generation cephalosporins • Cefdinir • Cefixime • Cefpodoxime • Ceftriaxone

Numerator

A group A Streptococcus test in the seven-day period from three days prior to the episode date through three days after the episode date.

Submission Codes (QDCs)

✓ Performance Met

3210FGroup A Strep Test Performed

✗ Performance Not Met

3210F with 8PGroup A Strep Test not Performed, reason not otherwise specified

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.

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VBCA Insights

💡Why This Measure Matters

This measure checks whether patients with sore throats get a Strep test before starting antibiotics, reducing unnecessary treatment of viral pharyngitis. Rapid or culture-confirmed Strep testing prevents prescribing antibiotics to the 70-80% of sore throats that are viral, limiting resistance while ensuring bacterial infections get treated. Always test before treating unless clinical probability is very high. Document test results and base antibiotic use on positive findings.

📖Clinical Rationale

Group A streptococcal (GAS) bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms. The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment.

Estimated economic costs of pediatric streptococcal pharyngitis in the United States range from $224 million to $539 million per year, including indirect costs related to parental work losses. At a higher level, the economic cost of antibiotic resistance vary but have extended as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion a year (2008 dollars) (Pfoh et al.

📝Clinical Recommendations

Infectious Disease Society of America (2012) The Infectious Diseases Society of America (IDSA) “recommends swabbing the throat and testing for GAS pharyngitis by rapid antigen detection test (RADT) and/or culture because the clinical features alone do not reliably discriminate between GAS and viral pharyngitis except when overt viral features like rhinorrhea, cough, oral ulcers, and/or hoarseness are present”

📋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 of this measure, this episode measure is submitted once for each occurrence of a particular illness or condition during the performance period. Telehealth

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Appropriate Testing for Pharyngitis

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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