Who is eligible for MIPS 191?

All cataract surgeries performed between January and September of the performance period for patients 18 years and older.

Is MIPS 191 the same as MIPS 191?

Yes. CMS uses zero-padded three-digit Quality IDs (191) in official specifications, while clinicians often search for MIPS 191 or Quality ID 191 without the leading zero. Both refer to the same 2026 MIPS quality measure reported through the Quality Payment Program (QPP).

What is the NQF number for MIPS Measure 191?

MIPS Measure 191 is associated with CBE/NQF number 565. It is also identified as eCQM CMS133v14. It can be reported through the Quality Payment Program (QPP) as a MIPS Clinical Quality Measure (CQM).

How do I report MIPS Measure 191 in 2026?

MIPS Measure 191 (Quality ID 191) is reported through the Quality Payment Program (QPP) as a MIPS Clinical Quality Measure (CQM) via qualified registry, eCQM, or Medicare Part B claims where applicable.

Is MIPS 191 a topped-out measure?

Yes, MIPS 191 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 191|Ophthalmology|2026 Performance Year

2026 MIPS Measure #191: Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery

Percentage of cataract surgeries for patients aged 18 years and older with a diagnosis of uncomplicated cataract and no significant ocular conditions impacting the visual outcome of surgery and had best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following the cataract surgery.

Outcome – High PriorityOphthalmologyPatient-Reported Outcomes

Measure ID:MIPS 191 (Quality ID 191)

eCQM:CMS133v14

CBE:565

Collection:MIPS CQM, eCQM

Topped Out:Yes

View CMS Spec ↗

Measure Specification

Eligible Population

Patients aged ≥18 years on date of procedure

ANDProcedure during the performance period

WITHOUTModifier: 56 or 55

Exclusions

M1439Any of the following significant ocular conditions that impact the visual outcome of surgery: M1439

Numerator

Cataract surgeries with best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following cataract surgery.

Reporting Codes

Performance Met:

4175FBest-corrected visual acuity of 20/40 or better (distance or near) achieved within the 90 days following cataract surgery

Performance Not Met:

4175F with 8PBest-corrected visual acuity of 20/40 or better (distance or near) not achieved within the 90 days following cataract surgery, reason not otherwise specified

VBCA Insights

Why This Measure Matters

Cataract surgery should restore useful vision—that's the whole point. This outcome measure checks what percentage of your uncomplicated cataract surgeries achieve 20/40 or better vision by 90 days post-op. Strong performance reflects good patient selection, optimal refractive targeting, and attention to minimizing intraoperative complications. If your rate is lower than expected, review your refractive predictions and complication rates to identify improvement areas.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 191 to the Quality Payment Program (QPP). Practices can report this measure as a MIPS Clinical Quality Measure (CQM), as an eCQM, or through qualified registry submission.

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Specialty Measure Sets

Ophthalmology

Related Measures

Ophthalmology

MIPS 117: Diabetes: Eye Exam MIPS 141: Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 20% OR MIPS 303: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract MIPS 304: Cataracts: Patient Satisfaction within 90 Days Following Cataract Surgery MIPS 384: Adult Primary Rhegmatogenous Retinal Detachment Surgery: No Return to the Operating MIPS 385: Adult Primary Rhegmatogenous Retinal Detachment Surgery: Visual Acuity Improvement MIPS 389: Cataract Surgery: Difference Between Planned and Final Refraction MIPS 499: Appropriate Screening and Plan of Care for Elevated Intraocular Pressure Following MIPS 500: Acute Posterior Vitreous Detachment Appropriate Examination and Follow-up MIPS 501: Acute Posterior Vitreous Detachment and Acute Vitreous Hemorrhage Appropriate

Patient-Reported Outcomes

MIPS 217: Functional Status Change for Patients with Knee Impairments MIPS 218: Functional Status Change for Patients with Hip Impairments MIPS 219: Functional Status Change for Patients with Lower Leg, Foot or Ankle Impairments MIPS 220: Functional Status Change for Patients with Low Back Impairments MIPS 221: Functional Status Change for Patients with Shoulder Impairments MIPS 222: Functional Status Change for Patients with Elbow, Wrist or Hand Impairments MIPS 303: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract MIPS 420: Varicose Vein Treatment with Saphenous Ablation: Outcome Survey MIPS 459: Back Pain After Lumbar Surgery MIPS 461: Leg Pain After Lumbar Surgery MIPS 470: Functional Status After Primary Total Knee Replacement MIPS 471: Functional Status After Lumbar Surgery MIPS 478: Functional Status Change for Patients with Neck Impairments MIPS 483: Person-Centered Primary Care Measure Patient Reported Outcome MIPS 485: Psoriasis – Improvement in Patient-Reported Itch Severity MIPS 486: Dermatitis – Improvement in Patient-Reported Itch Severity MIPS 505: Reduction in Suicidal Ideation or Behavior Symptoms

Official Resources

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

Clinical Rationale

In the United States, cataracts affect more than 24 million adults over 40 years. According to the American Academy of Ophthalmology (Academy), cataract surgery has a substantial beneficial impact on visual function and on quality of life. 1. Scientific basis for measuring visual acuity outcomes after cataract surgery: The only reason to perform cataract surgery (other than for a limited set of medical indications) is to improve a patient’s vision and associated functioning.

The use of a 20/40 visual acuity threshold is based on several considerations. First, it is the level for unrestricted operation of a motor vehicle in the US. Second, it has been consistently used by the FDA in its assessment for approval of intraocular lens (IOL) and other vision devices. Third, it is the literature standard to denote success in cataract surgery.

Fourth, work by West et al. in the Salisbury Eye Study suggests that 20/40 is a useful threshold for 50th percentile functioning for several vision- related tasks. Most patients achieve excellent visual acuity after cataract surgery (20/40 or better). This outcome is achieved consistently through careful attention through the accurate measurement of axial length and corneal power and the appropriate selection of an IOL power calculation formula.

As such, it reflects the care and diligence with which the surgery is assessed, planned and executed. Failure to achieve this after surgery in eyes without comorbid ocular conditions that would impact the success of the surgery would reflect care that should be assessed for opportunities for improvement. The exclusion of patients with other ocular and systemic conditions known to increase the risk of an adverse outcome reflects the findings of the two published prediction rule papers for cataract surgery outcomes, by Mangione et al.

and Steinberg et al.. In both papers, the presence of comorbid glaucoma and macular degeneration negatively impacted the likelihood of successful outcomes of surgery. Further, as noted in the prior indicator, exclusion of eyes with ocular conditions that could impact the success of the surgery would NOT eliminate the large majority of eyes undergoing surgery while also minimizing the potential adverse selection that might otherwise occur relative to those patients with the most complex situations who might benefit the most from having surgery to maximize their remaining vision.

2. Evidence of a gap in care Cataract surgery successfully restores vision in the majority of people who have the procedure. Data from a study of 368,256 cataract surgeries show that corrected visual acuity (CDVA) of 0.5 (20/40) or better was achieved in 94.3% and CDVA of 1.0 (20/20) or better was achieved in 61.3% of cases. Additionally, data from a UK multi-center Cataract National Dataset found a postoperative visual acuity of 6/12 (20/40) or better was achieved for 94.

7% of eyes with no co-pathologies and in 79.9% of eyes with one or more co-pathologies. A rate of 85.5-94.7% of patients achieving a 20/40 or better visual acuity in the context of approximately 3 million cataract surgeries in the US annually would mean that between 160,000 to 435,000 individuals would not achieve a 20/40 or better visual acuity which suggests an opportunity for improvement.

Clinical Recommendations

This is an outcome measure. As such, there is no statement in the guideline specific to this measurement topic.

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 procedure measure is submitted each time a procedure is performed. This is an outcome measure and will be calculated solely using Merit-based Incentive Payment System (MIPS) eligible clinician, group, or third-party intermediary submitted data.

• For patients who receive the cataract surgical procedures specified in the denominator coding, it should be reported whether or not the patient had best-corrected visual acuity of 20/40 or better achieved in the operative eye within 90 days following cataract surgery. • Cataract surgeries performed on patients who have any of the listed significant ocular conditions [comorbid] in the exclusion criteria should be removed from the denominator; these patients have existing ocular conditions that could impact the outcome of surgery and are not included in the measure calculation for those patients who have best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following the cataract surgery.

• Include only cataract surgery procedures performed between January 1st and September 30th of the performance period. This will allow the post-operative period to occur within the performance period. • The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction).

Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality.

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