Who is eligible for MIPS 249?

All surgical pathology esophageal biopsy reports for Barrett’s Esophagus.

Is MIPS 249 the same as MIPS 249?

Yes. CMS uses zero-padded three-digit Quality IDs (249) in official specifications, while clinicians often search for MIPS 249 or Quality ID 249 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 249: Barrett’s Esophagus?

Submission codes: 3126F (Esophageal biopsy reports with the histological finding of Barrett’s mucosa that contains a statement about dysplasia (present, absent, or indefinite and if present, contains appropriate grading)); 3126F with 8P (Pathology report with the histological finding of Barrett’s mucosa that does not contain a statement about dysplasia (present, absent, or indefinite, and if present, contains appropriate grading), reason not otherwise specified)

How do I report MIPS Measure 249 in 2026?

MIPS Measure 249 (Quality ID 249) 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 249 a topped-out measure?

Yes, MIPS 249 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 249|Gastroenterology|2026 Performance Year

2026 MIPS Measure #249: Barrett’s Esophagus

Percentage of esophageal biopsy reports that document the presence of Barrett’s mucosa that also include a statement about dysplasia.

ProcessGastroenterologyOncology

Measure ID:MIPS 249 (Quality ID 249)

Collection:MIPS CQM, Part B Claims

Topped Out:Yes

View CMS Spec ↗

Measure Specification

Eligible Population

Diagnosis for Barrett’s Esophagus

ANDPatient procedure during the performance period

Exclusions

None

Numerator

Esophageal biopsy report documents the presence of Barrett’s mucosa and includes a statement about dysplasia.

Reporting Codes

Performance Met:

3126FEsophageal biopsy reports with the histological finding of Barrett’s mucosa that contains a statement about dysplasia (present, absent, or indefinite and if present, contains appropriate grading)

Performance Not Met:

3126F with 8PPathology report with the histological finding of Barrett’s mucosa that does not contain a statement about dysplasia (present, absent, or indefinite, and if present, contains appropriate grading), reason not otherwise specified

○ Exceptions:

Documentation of medical reason(s) for not submitting the histological finding of Barrett’s mucosa (e.g., malignant neoplasm or absence of intestinal metaplasia) (3126F with 1P)

G8797Specimen site other than anatomic location of esophagus

VBCA Insights

Why This Measure Matters

Barrett's esophagus significantly raises cancer risk, so when you find it on biopsy, you must document the dysplasia status. This measure checks whether Barrett's biopsy reports include a statement about dysplasia presence or absence. Clear dysplasia assessment guides surveillance intervals and treatment decisions; vague reports force repeat biopsies. Work with pathology to ensure every Barrett's report includes definitive dysplasia language.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 249 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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Specialty Measure Sets

Pathology

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Official Resources

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

Clinical Rationale

Endoscopy is the technique of choice used to identify suspected Barrett’s esophagus and to diagnose complications of GERD. Biopsy must be added to confirm the presence of Barrett’s epithelium and to evaluate for dysplasia. There is a rapidly rising incidence of adenocarcinoma of the esophagus in the United States. A diagnosis of Barrett’s esophagus increases a patient’s risk for esophageal adenocarcinoma by 30 to 125 times that of people without Barrett’s esophagus (although this risk is still small 0.

4% to 0.5% per year). Esophageal adenocarcinoma is often not curable, partly because the disease is frequently discovered at a late stage and because treatments are not effective. A diagnosis of Barrett’s esophagus could allow for appropriate screening of at risk patients as recommended by the American College of Gastroenterology. Standard endoscopy with biopsy currently is the most reliable means of establishing a diagnosis of Barrett’s esophagus.

The definitive diagnosis of Barrett’s esophagus requires a pathologist’s review of an esophageal biopsy. Dysplasia is the first step in the neoplastic process, and information about dysplasia is crucial for clinical decision-making directing therapy. The presence and grade of dysplasia cannot be determined by routine endoscopy, and pathologist’s review of a biopsy is essential for recognition of dysplasia, especially given that there are no recommended biomarkers for Barrett’s esophagus.

Endoscopic surveillance detects curable neoplasia in patients with Barrett’s esophagus.

Clinical Recommendations

The diagnosis of Barrett’s esophagus requires systematic biopsy of the abnormal-appearing esophageal mucosa to document intestinal metaplasia and to detect dysplasia (ACG, 2022).

Implementation Notes

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For purposes of MIPS implementation, this procedure measure is submitted each time a procedure is performed during the performance period. Only one quality data code (QDC) (or equivalent) per date of procedure for each patient is required.

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