Measure ID: MIPS 176|Infectious Disease|2026 Performance Year

2026 MIPS Measure #176: 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
Measure ID:MIPS 176 (Quality ID 176)
Collection:MIPS CQM
Topped Out:Yes
View CMS Spec ↗

Measure Specification

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
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.
Reporting Codes

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

○ Exceptions:

M1004Documentation 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)
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.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 176 to the Quality Payment Program (QPP). Practices can report this measure as a MIPS Clinical Quality Measure (CQM) or through qualified registry submission.

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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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