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.

Is MIPS 66 the same as MIPS 066?

Yes. CMS uses zero-padded three-digit Quality IDs (066) in official specifications, while clinicians often search for MIPS 66 or Quality ID 66 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 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)

How do I report MIPS Measure 066 in 2026?

MIPS Measure 066 (Quality ID 66) 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 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

2026 MIPS Measure #066: 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

Measure ID:MIPS 066 (Quality ID 66)

eCQM:CMS146v14

Collection:MIPS CQM, eCQM

Topped Out:Yes

View CMS Spec ↗

Measure Specification

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

Exclusions

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.

Reporting Codes

Performance Met:

3210FGroup A Strep Test Performed

Performance Not Met:

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

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.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 066 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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Specialty Measure Sets

Emergency Medicine Family Medicine Infectious Disease Otolaryngology Pediatrics Urgent Care

Related Measures

Appropriate Use

MIPS 065: Appropriate Treatment for Upper Respiratory Infection (URI)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 065: Appropriate Treatment for Upper Respiratory Infection (URI)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 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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