Who is eligible for MIPS 180?

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 180 a topped-out measure?

Yes, MIPS 180 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 180|Rheumatology|2026 Performance Year

Rheumatoid Arthritis (RA): Glucocorticoid Management

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 who have been assessed for glucocorticoid use and, for those on prolonged doses of prednisone >5 mg daily (or equivalent) with improvement or no change in disease activity, documentation of glucocorticoid management plan during the performance period.

ProcessRheumatologyMedication Management

Last updated: January 15, 2026

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Measure Specification

Denominator (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: M1376

ORPerformance Met: Patient receiving ≤5 mg daily prednisone (or equivalent), or RA activity is worsening, or glucocorticoid use is for less than 6 months (G2112)

ORPerformance Met: Patient receiving > 5 mg daily prednisone (or equivalent) for longer than 6 months, and improvement or no change in disease activity (G2113)

ANDGlucocorticoid Management Plan documented (0540F)

ORDenominator Exception: Documentation of medical reason(s) for not documenting glucocorticoid management plan (i.e., glucocorticoid prescription is for a medical condition other than RA) (0540F with 1P)

ANDPatient receiving > 5 mg daily prednisone (or equivalent) for longer than 6 months, and improvement or no change in disease activity (G2113)

ORPerformance Not Met: Glucocorticoid dose was not documented, reason not otherwise specified (4194F with 8P)

ORPerformance Not Met: Glucocorticoid management plan not documented, reason not otherwise specified (0540F with 8P)

ANDPatient receiving >5 mg daily prednisone (or equivalent) for longer than 6 months, and improvement or no change in disease activity (G2113)

Denominator Exclusions

None

Numerator

Patients who have been assessed for glucocorticoid use and for those on prolonged doses of prednisone > 5 mg daily (or equivalent) with improvement or no change in disease activity, documentation of a glucocorticoid management plan during the performance period.

Submission Codes (QDCs)

✓ Performance Met

4192FPatient not receiving glucocorticoid therapy

G2112Patient receiving ≤5 mg daily prednisone (or equivalent), or RA activity is worsening, or glucocorticoid use is for less than 6 months

G2113Patient receiving > 5 mg daily prednisone (or equivalent) for longer than 6 months, and improvement or no change in disease activity

✗ Performance Not Met

4194F with 8PGlucocorticoid dose was not documented, reason not otherwise specified

0540F with 8PGlucocorticoid management plan not documented, reason not otherwise specified

Denominator Exceptions

Denominator Exception: Documentation of medical reason(s) for not documenting glucocorticoid management plan (i.e., glucocorticoid prescription is for a medical condition other than RA) (0540F with 1P)

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VBCA Insights

💡Why This Measure Matters

Long-term steroids for RA carry real risks—bone loss, infection, metabolic effects—so they should be used sparingly and always with a plan to taper. This measure verifies you've documented steroid assessment and a management plan for RA patients taking prednisone over 5 mg daily with stable or improving disease. If a patient's doing well, the plan should be explicit: continue, taper, or transition to another agent. This documentation keeps steroid use honest and purposeful.

📖Clinical Rationale

Glucocorticoids are an important part of RA treatment as they inhibit inflammation and may control synovitis. However, long-term use of glucocorticoids, especially at high doses, should be avoided, due to the potential health complications. Monitoring length and dose of glucocorticoid treatment for patients with RA is integral to making other clinical decisions.

📝Clinical Recommendations

Low-dose oral glucocorticoids and local injections of glucocorticoids are highly effective for relieving symptoms in patients with active RA. The benefits of low-dose systemic glucocorticoids, however, should always be weighed against their adverse effects. The adverse effects of long-term oral glucocorticoids at low doses are protean and include osteoporosis, hypertension, weight gain, fluid retention, hyperglycemia, cataracts, and skin fragility, as well as the potential for premature atherosclerosis.

These adverse effects should be considered and should be discussed in detail with the patient before glucocorticoid therapy is begun. For long term disease control, the glucocorticoid dosage should be kept to a minimum. For the majority of patients with RA, this means equal or less than 10 mg of prednisone per day. (ACR, 2002) Grijalva, et al found nearly two-fold greater serious infection (OR1.

78 1.47,2.15) at 5-10 mg of prednisone in RA as reported in JAMA 2011 Dec 7;306(21):2331-9. doi: 10.1001/jama.2011.1692. Epub 2011 Nov 6. Because of the dangers to patients associated with being on 5 to 10 mg doses of prednisone, optimal treatment is to aim for a dosage less than or equal to 5 mg.

📋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.

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Rheumatoid Arthritis (RA): Glucocorticoid Management

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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Official Resources

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