Measure ID: MIPS 178·Rheumatology·2026 Performance Year

2026 MIPS Measure #178: Rheumatoid Arthritis (RA): Functional Status Assessment

Percentage of patients aged 18 years and older with two or more encounters with a diagnosis of rheumatoid arthritis (RA) at least 90 days apart for whom a functional status assessment was performed at least once during the performance period.

ProcessRheumatologyFunctional Assessment

Measure ID:MIPS 178 (Quality ID 178)

Collection:MIPS CQM

Topped Out:Yes

View CMS Spec ↗

Measure Specification

Eligible Population

Patients aged ≥ 18 years on date of encounter

ANDDiagnosis for rheumatoid arthritis(RA)

ANDPatient encounter during the performance period

ANDAn additional encounter with an RA diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an RA diagnosis during the performance period: M1375

Exclusions

None

Numerator

Patients for whom a functional status assessment using an ACR-preferred, patient-reported functional status assessment tool was performed at least once during the performance period.

Reporting Codes

Performance Met:

1170FFunctional status assessed

Performance Not Met:

1170F with 8PFunctional status not assessed, reason not otherwise specified

VBCA Insights

Why This Measure Matters

RA patients care deeply about function—what they can do at home and work—but it often gets overlooked in routine visits. This measure confirms you're assessing functional status at least once using a validated tool like the HAQ or PROMIS. Understanding your patient's actual limitations informs realistic treatment goals and catches functional decline before major disability happens. A single functional assessment during the measurement year is the bar here.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 178 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 178 Benchmarks

Historical CMS benchmark deciles for MIPS quality measure 178 by collection type. Your performance rate falls into a decile, which determines your measure points (3–10).

MIPS CQMAvg. performance rate: 91.32%Topped Out — 7-point cap

Decile	Performance Rate Range	Points
Decile 1	0.11 - 64.72%	1 – 1.9
Decile 2	64.73 - 90.90%	2 – 2.9
Decile 3	90.91 - 97.52%	3 – 3.9
Decile 4	97.53 - 99.39%	4 – 4.9
Decile 5	99.40 - 99.88%	5 – 5.9
Decile 6	99.89 - 99.99%	6 – 6.9
Decile 10	100.00%	10

Specialty Measure Sets

Orthopedic Surgery Rheumatology

Related Measures

Rheumatology

MIPS 176: Tuberculosis Screening Prior to First Course of Biologic and/or Immune Response MIPS 177: Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity MIPS 180: Rheumatoid Arthritis (RA): Glucocorticoid Management

Functional Assessment

MIPS 048: Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in MIPS 050: Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years 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 182: Functional Outcome Assessment MIPS 282: Dementia: Functional Status Assessment MIPS 502: Improvement or Maintenance of Functioning for Individuals with a Mental and/or

Official Resources

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

Clinical Context

Clinical Rationale

Functional limitations are a significant and disruptive complication for patients living with RA. Assessments of functional limitations are used to assess prognosis and guide treatment and therapy decisions. According to the ACR’s RA treatment guidelines, functional status assessment using a standardized, validated measure should be performed routinely for RA patients, at least once per year, but more frequently if disease is active.

Clinical Recommendations

The management of RA is an iterative process, and patients should be routinely reassessed for evidence of disease or limitation of function with significant alteration of joint anatomy. Baseline evaluation of disease activity and damage in patients with rheumatoid arthritis through evaluation of functional status or quality of life assessments using standardized questionnaires, a physician’s global assessment of disease activity, or patient’s global assessment of disease activity.

The initial evaluation of the patient with RA should document symptoms of active disease (i.e., presence of joint pain, duration of morning stiffness, degree of fatigue), functional status, objective evidence of disease activity (i.e., synovitis, as assessed by tender and swollen joint counts, and the ESR or CRP level), and mechanical joint problems.

At each follow up visit, the physician must assess whether the disease is active or inactive. Symptoms of inflammatory (as contrasted with mechanical) joint disease, which include prolonged morning stiffness, duration of fatigue, and active synovitis on joint examination, indicate active disease and necessitate consideration of changing the treatment program.

Occasionally, findings of the joint examination alone may not adequately reflect disease activity and structural damage; therefore, periodic measurements of the ESR or CRP level and regular assessments of functional status, as well as periodic radiographic examinations of involved joints should be performed. It is important to determine whether a decline in function is the result of inflammation, mechanical damage, or both; treatment strategies will differ accordingly.

(ACR, 2002) The ACR also conducted an extensive multi-year project, involving systematic literature reviews, expert consensus ratings, and national surveys to reach consensus on which RA patient-reported functional status assessments tools are valid, reliable, and responsive, and feasible to implement in routine clinical practice, resulting in three ACR-preferred functional status assessment tools (cite: https://rheumatology.

org/api/asset/blt65c03d5b72bc6cc2).

Implementation Notes

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.

Frequently Asked Questions

Who is eligible for MIPS 178?

Patients aged 18 years and older with two or more RA diagnoses documented at least 90 days apart with at least one encounter with an RA diagnosis occurring during the performance period and an additional encounter with an RA diagnosis occurring in the performance period or prior performance period. Definitions: Encounter – An encounter during the performance period where one of the CPT or HCPCS codes listed in the patient encounter criteria is used. Additional encounter – An additional encounter during the performance period or prior performance period where one of the CPT or HCPCS codes listed in the patient encounter is used to confirm an RA diagnosis with ICD-10-CM diagnosis codes as listed in the Denominator criteria.

Is MIPS 178 the same as MIPS 178?

Yes. CMS uses zero-padded three-digit Quality IDs (178) in official specifications, while clinicians often search for MIPS 178 or Quality ID 178 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 178: Rheumatoid Arthritis (RA): Functional Status Assessment?

Submission codes: 1170F (Functional status assessed); 1170F with 8P (Functional status not assessed, reason not otherwise specified)

How do I report MIPS Measure 178 in 2026?

MIPS Measure 178 (Quality ID 178) 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 178 a topped-out measure?

Yes, MIPS 178 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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