Who is eligible for MIPS 176?

All patients aged 18 years and older who are receiving a first course of therapy using a biologic and/or immune response modifier (such as janus kinase inhibitors) that includes a warning for potential reactivation of a latent infection. Denominator Instructions: Patients are considered to be receiving a first course of therapy using a biologic and/or immune response modifier that includes a warning for potential reactivation of a latent infection only if they have been prescribed such a biologic and/or immune response modifier during the performance period and also have not been prescribed any such biologic and/or immune response modifier in the 15 months preceding the encounter at which the biologic and/or immune response modifier was newly started. The list of biologic and/or immune response modifier therapies are subject to change as new therapies are approved by the FDA. Newly approved biologic and/or immune response modifier therapies requiring TB testing prior to the first course of therapy would be eligible for inclusion within the Denominator even if not listed within the Table 1.

Is MIPS 176 a topped-out measure?

Yes, MIPS 176 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 176|Infectious Disease|2026 Performance Year

Tuberculosis Screening Prior to First Course of Biologic and/or Immune Response

If a patient has been newly prescribed a biologic and/or immune response modifier that includes a warning for potential reactivation of a latent infection, then the medical record should indicate TB testing in the preceding 12-month period.

ProcessInfectious DiseaseRheumatology

Last updated: January 15, 2026

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Measure Specification

Denominator (Eligible Population)

Patients aged ≥ 18 years on date of encounter

ANDPatient encounter during the performance period

ANDPatient receiving first-time biologic and/or immune response modifier therapy: G2182

ORDenominator Exception: Documentation of medical reason for not screening for TB or interpreting results (i.e., patient positive for TB and documentation of past treatment; patient who has recently completed a course of anti-TB therapy) (M1004)

ORPerformance Not Met: TB screening not performed or results not interpreted, reason not given (M1005)

Denominator Exclusions

None

Numerator

Patients for whom any record of TB testing is documented or performed (PPD or TST, IFN-gamma release assays, or other appropriate method) in the medical record in the 12 months preceding the biologic and/or immune response modifier prescription.

Submission Codes (QDCs)

✓ Performance Met

M1003TB screening performed and results interpreted within twelve months prior to initiation of first-time biologic and/or immune response modifier therapy

✗ Performance Not Met

M1005TB screening not performed or results not interpreted, reason not given

Denominator Exceptions

M1004Denominator Exception: Documentation of medical reason for not screening for TB or interpreting results (i.e., patient positive for TB and documentation of past treatment; patient who has recently completed a course of anti-TB therapy)

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VBCA Insights

💡Why This Measure Matters

Before starting a patient on biologics or immune modulators, TB screening is essential because these drugs sharply increase reactivation risk. This measure ensures your team documents TB testing (skin test, blood test, or equivalent) in the 12 months before prescribing. Performance gap typically comes from administrative delays rather than clinical judgment. Create a pre-prescription checklist so TB testing becomes automatic for all biologic candidates.

📖Clinical Rationale

Regardless of a patient's diagnosis, it is essential to screen the patient for tuberculosis before initiating therapy with a biologic and/or immune response modifier, as research has documented a higher incidence of TB after anti-TNFα therapy. All patients being considered for a biologic and/or immune response modifier should receive a TB test (tuberculin skin test or blood test), even if the patient has previously received the BCG vaccination.

Test results, in addition to patient risk for TB and other tests, should be used to assess the patient’s risk for latent TB infection (also called inactive TB); for documented latent TB infection, treatment with isoniazid or similar medication should be started prior to or concurrent with biologic initiation as clinically appropriate (https://www.cdc.

gov/tb/publications/ltbi/default.htm).

📝Clinical Recommendations

The American College of Rheumatology recommends screening to identify latent TB infection (LTBI) in all RA patients being considered for therapy with biologic agents, regardless of the presence of risk factors for LTBI. (Level of Evidence: C) (ACR, 2012) Multiple studies have found similarly increased risks of latent TB reactivation with biologics in other auto-inflammatory syndromes other than RA, such as inflammatory bowel disease, ankylosing spondylitis and psoriasis.

This has led to many consensus statements supporting screening of latent TB prior to initiation of a range of biologic and/or immune response modifiers in a range of autoimmune/auto-inflammatory diseases (Hasan, 2018Doherty, 2008), supporting that this measure applies to a broad population of patients being considered for biologic and/or immune response modifier therapy.

📋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 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.

To be included in the denominator, patient must have an encounter and a prescription for a biologic and/or immune response modifier in the performance period (1/1/2026-12/31/2026) WITHOUT a prior prescription for a biologic and/or immune response modifier within the 15 months prior to the biologic and/or immune response modifier prescribed during the performance period.

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Tuberculosis Screening Prior to First Course of Biologic and/or Immune Response

Measure Specification

Denominator (Eligible Population)

Denominator Exclusions

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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Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity

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Rheumatoid Arthritis (RA): Glucocorticoid Management

Official Resources

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