Measure ID: MIPS 118·Cardiology·2026 Performance Year

2026 MIPS Measure #118: Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE)

Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12- month period who also have diabetes OR a current or prior Left Ventricular Ejection Fraction (LVEF) ≤ 40% who were prescribed ACE inhibitor or ARB therapy.

ProcessCardiologyEndocrinologyMedication Management

Measure ID:MIPS 118 (Quality ID 118)

CBE:66

Collection:MIPS CQM

Topped Out:Yes

View CMS Spec ↗

Measure Specification

This measure produces 2 performance rates. Each rate has its own eligible population, numerator, and reporting codes.

Rate 1

Eligible Population

Patients aged ≥ 18 years on date of encounter

ANDDiagnosis for coronary artery disease on date of encounter

ANDPatient encounter during the performance period

ANDAt least one additional patient encounter during performance period

ANDCurrent or prior left ventricular ejection fraction (LVEF) ≤ 40% or documentation of moderately or severely depressed left ventricular systolic function: G8934

Exclusions

None

Numerator

Patients who were prescribed ACE inhibitor or ARB therapy.

Reporting Codes

Performance Met:

G8935Clinician prescribed angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy

Performance Not Met:

G8937Clinician did not prescribe angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy, reason not given

○ Exceptions:

G8936Clinician documented that patient was not an eligible candidate for angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy (e.g., allergy, intolerance, pregnancy, renal failure due to ACE inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (e.g., patient declined, other patient reasons)

Rate 2

Eligible Population

ORAll patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have diabetes.

ANDDiagnosis for coronary artery disease on date of encounter

ANDDiagnosis for diabetes on date of encounter

ANDPatient encounter during the performance period

ANDAt least one additional patient encounter during performance period

Exclusions

None

Reporting Codes

Performance Met:

G8473Angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy prescribed

Performance Not Met:

G8475Angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy not prescribed, reason not given

○ Exceptions:

G8474Angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy not prescribed for reasons documented by the clinician (e.g., allergy, intolerance, pregnancy, renal failure due to ACE inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (e.g., patient declined, other patient reasons)

VBCA Insights

Why This Measure Matters

This measure checks whether CAD patients with diabetes or weakened heart function are on ACE inhibitors or ARBs, which reduce heart attacks and deaths in this high-risk group. These medications protect the heart and kidneys in diabetic patients and reduce mortality after MI or in systolic dysfunction. Prescribe unless there's a documented contraindication. Monitor blood pressure and kidney function, especially at the start of therapy.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 118 to the Quality Payment Program (QPP). Practices can report this measure as a MIPS Clinical Quality Measure (CQM) or through qualified registry submission.

🧮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.

2026 MIPS 118 Benchmarks

Historical CMS benchmark deciles for MIPS quality measure 118 by collection type. Your performance rate falls into a decile, which determines your measure points (3–10).

MIPS CQMAvg. performance rate: 91.08%Topped Out

Decile	Performance Rate Range	Points
Decile 1	47.46 - 76.48%	1 – 1.9
Decile 2	76.49 - 82.64%	2 – 2.9
Decile 3	82.65 - 86.62%	3 – 3.9
Decile 4	86.63 - 90.77%	4 – 4.9
Decile 5	90.78 - 96.60%	5 – 5.9
Decile 6	96.61 - 99.99%	6 – 6.9
Decile 10	100.00%	10

Specialty Measure Sets

Cardiology Endocrinology Skilled Nursing Facility

Related Measures

Cardiology

MIPS 006: Coronary Artery Disease (CAD): Antiplatelet Therapy MIPS 007: Coronary Artery Disease (CAD): Beta-Blocker Therapy – Prior Myocardial MIPS 326: Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy MIPS 438: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease MIPS 441: Ischemic Vascular Disease (IVD) All or None Outcome Measure (Optimal Control)

Endocrinology

MIPS 001: Diabetes: Glycemic Status Assessment Greater Than 9%MIPS 117: Diabetes: Eye Exam MIPS 126: Diabetes Mellitus: Diabetic Foot and Ankle Care Peripheral Neuropathy – Neurological Evaluation MIPS 127: Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention – Evaluation of MIPS 336: Maternity Care: Postpartum Follow-up and Care Coordination MIPS 438: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease MIPS 488: Kidney Health Evaluation

Medication Management

MIPS 005: Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or MIPS 007: Coronary Artery Disease (CAD): Beta-Blocker Therapy – Prior Myocardial MIPS 008: Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic MIPS 130: Documentation of Current Medications in the Medical Record MIPS 180: Rheumatoid Arthritis (RA): Glucocorticoid Management MIPS 268: Epilepsy: Counseling for Women of Childbearing Potential with Epilepsy MIPS 410: Psoriasis: Clinical Response to Systemic Medications MIPS 468: Continuity of Pharmacotherapy for Opioid Use Disorder (OUD)MIPS 489: Adult Kidney Disease: Angiotensin Converting Enzyme (ACE) Inhibitor or MIPS 490: Appropriate Intervention of Immune-Related Diarrhea and/or Colitis in Patients Treated

Official Resources

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

Clinical Context

Clinical Rationale

Nonadherence to cardioprotective medications is prevalent among outpatients with coronary artery disease and can be associated with a broad range of adverse outcomes, including all-cause and cardiovascular mortality, cardiovascular hospitalizations, and the need for revascularization procedures. In the absence of contraindications, ACE inhibitors or ARBs are recommended for all patients with a diagnosis of coronary artery disease and diabetes or reduced left ventricular systolic function.

ACE inhibitors remain the first choice, but ARBs can now be considered a reasonable alternative. Both pharmacologic agents have been shown to decrease the risk of death, myocardial infarction, and stroke. Additional benefits of ACE inhibitors include the reduction of diabetic symptoms and complications for patients with diabetes.

Clinical Recommendations

The following evidence statements are quoted verbatim from the referenced clinical guidelines. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the management of patients with chronic coronary disease (CCD): In patients with CCD who also have hypertension, diabetes, LVEF <=40%, or CKD, the use of ACE inhibitors, or ARBs if ACE inhibitor-intolerant, is recommended to reduce cardiovascular events.

(Class 1 Recommendation, Level of Evidence A) 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease (SIHD) (ACCF/AHA/ACP/AATS/PCNA/SCAI/STS, 2012) RENIN-ANGIOTENSIN-ALDOSTERONE BLOCKER THERAPY ACE inhibitors should be prescribed in all patients with SIHD who also have hypertension, diabetes mellitus, LVEF 40% or less, or CKD, unless contraindicated.

(Class I Recommendation, Level of Evidence: A) ARBs are recommended for patients with SIHD who have hypertension, diabetes mellitus, LV systolic dysfunction, or CKD and have indications for, but are intolerant of, ACE inhibitors.

Implementation Notes

This measure contains two strata defined by two submission criteria. This measure produces a single performance rate using a weighted average. There are 2 Submission Criteria for this measure: 1) Patients who are 18 years and older with a diagnosis of CAD with LVEF ≤ 40% OR 2) Patients who are 18 years and older with a diagnosis of CAD who have diabetes If the patient has CAD and LVSD (without a diagnosis of diabetes), use Denominator Submission Criteria 1.

If the patient has CAD and diabetes, use Denominator Submission Criteria 2. If the patient has both diabetes and LVSD, the eligible professional may submit quality data for Submission Criteria 2 and this will count as appropriate submission for this patient. Both submission criteria should be submitted as appropriate. For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient for the performance period.

The most advantageous quality data code will be used if the measure is submitted more than once. The MIPS eligible clinician should submit data on one of the submission criteria, depending on the clinical findings.

Frequently Asked Questions

Who is eligible for MIPS 118?

DENOMINATOR (CRITERIA 1): All patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have a current or prior LVEF ≤ 40%. Definition: LVEF ≤ 40% – corresponds to qualitative documentation of moderate dysfunction or severe dysfunction. DENOMINATOR (CRITERIA 2): All patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have diabetes. Definition: Submission Criteria #2 – If a patient has both diabetes and LVSD, submission criteria #2 will count as appropriate submission for this patient.

Is MIPS 118 the same as MIPS 118?

Yes. CMS uses zero-padded three-digit Quality IDs (118) in official specifications, while clinicians often search for MIPS 118 or Quality ID 118 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 118: Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE)?

Submission codes: G8935 (Clinician prescribed angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy); G8473 (Angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy prescribed); G8937 (Clinician did not prescribe angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy, reason not given); G8475 (Angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy not prescribed, reason not given)

What is the NQF number for MIPS Measure 118?

MIPS Measure 118 is associated with CBE/NQF number 66. It can be reported through the Quality Payment Program (QPP) as a MIPS Clinical Quality Measure (CQM).

How do I report MIPS Measure 118 in 2026?

MIPS Measure 118 (Quality ID 118) is reported through the Quality Payment Program (QPP) as a MIPS Clinical Quality Measure (CQM) via qualified registry, or Medicare Part B claims where applicable.

Is MIPS 118 a topped-out measure?

Yes, MIPS 118 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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