Who is eligible for MIPS 261?

All patients aged birth and older presenting with acute or chronic dizziness.

Is MIPS 261 the same as MIPS 261?

Yes. CMS uses zero-padded three-digit Quality IDs (261) in official specifications, while clinicians often search for MIPS 261 or Quality ID 261 without the leading zero. Both refer to the same 2026 MIPS quality measure reported through the Quality Payment Program (QPP).

How do I report MIPS Measure 261 in 2026?

MIPS Measure 261 (Quality ID 261) 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 261 a topped-out measure?

No, MIPS 261 is not topped out, meaning there is still meaningful performance variation across clinicians.

Measure ID: MIPS 261|Otolaryngology|2026 Performance Year

2026 MIPS Measure #261: Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness

Percentage of patients aged birth and older referred to a physician (preferably a physician specially trained in disorders of the ear) for an otologic evaluation subsequent to an audiologic evaluation after presenting with acute or chronic dizziness.

Process – High PriorityOtolaryngologyAppropriate Use

Measure ID:MIPS 261 (Quality ID 261)

Collection:MIPS CQM, Part B Claims

Topped Out:No

View CMS Spec ↗

Measure Specification

Eligible Population

Patients aged birth and older

ANDDiagnosis for Dizziness

ANDPatient encounter during the performance period

WITHOUTEncounters conducted via telehealth: M1440

Exclusions

None

Numerator

Patients referred to a physician for an otologic evaluation subsequent to an audiologic evaluation who present with acute or chronic dizziness. _NUMERATOR NOTE:_ The physician receiving the referral, or providing care currently, should preferably be specially trained in disorders of the ear. Denominator exception will be determined on the date of the denominator eligible encounter.

Reporting Codes

Performance Met:

G8856Referral to a physician for an otologic evaluation performed

Performance Not Met:

G8858Referral to a physician for an otologic evaluation not performed, reason not given

○ Exceptions:

G8857Patient is not eligible for the referral for otologic evaluation measure (e.g., patients who are already under the care of a physician for acute or chronic dizziness)

VBCA Insights

Why This Measure Matters

When patients come to you with dizziness, you typically start with hearing tests. This measure tracks whether you follow up with an ear specialist—someone trained in inner ear problems—to find the root cause. Untreated dizziness can be disabling and may signal serious conditions like vestibular dysfunction. Make sure you're documenting and completing referrals to otolaryngology or a physician specializing in ear disorders after your audiologic workup. A clear handoff to the right specialist ensures patients get the full diagnostic picture.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 261 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

Audiology

Related Measures

Otolaryngology

MIPS 331: Adult Sinusitis: Antibiotic Prescribed for Acute Viral Sinusitis (Overuse)MIPS 332: Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin With or Without Clavulanate

Appropriate Use

MIPS 065: Appropriate Treatment for Upper Respiratory Infection (URI)MIPS 066: Appropriate Testing for Pharyngitis MIPS 102: Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate MIPS 116: Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis MIPS 277: Sleep Apnea: Severity Assessment at Initial Diagnosis MIPS 331: Adult Sinusitis: Antibiotic Prescribed for Acute Viral Sinusitis (Overuse)MIPS 332: Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin With or Without Clavulanate MIPS 335: Maternity Care: Elective Delivery (Without Medical Indication) at < 39 Weeks (Overuse)MIPS 360: Optimizing Patient Exposure to Ionizing Radiation: Count of Potential High Dose MIPS 364: Optimizing Patient Exposure to Ionizing Radiation: Appropriateness: Follow-up CT MIPS 405: Appropriate Follow-up Imaging for Incidental Abdominal Lesions MIPS 406: Appropriate Follow-up Imaging for Incidental Thyroid Nodules in Patients MIPS 416: Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt MIPS 421: Appropriate Assessment of Retrievable Inferior Vena Cava (IVC) Filters for Removal

Official Resources

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

Clinical Rationale

Studies demonstrate that patients who present with acute or chronic dizziness may suffer from underlying problems, so therefore referral is necessary. Without referral, patients may suffer consequences of the underlying problems.

Clinical Recommendations

The American Academy of Otolaryngology-Head and Neck Surgery policy statement (approved 9/12/2002): Hearing loss and balance disorders are medical conditions. Only licensed physicians with medical training may diagnose and direct the management of disease and medical disorders. A full history and physical examination by a physician (preferably a physician specially trained in disorders of the ear) to determine the accurate medical diagnosis and appropriate medical/surgical treatment for hearing loss and balance disorders are indicated for patients with the following “red flags”: 1) Hearing loss with a positive history of familial hearing loss, TB, syphilis, HIV, Meniere’s disease, autoimmune disorder, otosclerosis, von Recklinghausen’s neurofibromatosis, Paget’s disease of bone, head trauma related to onset.

2) History of pain, active drainage, or bleeding from an ear. 3) Sudden onset or rapidly progressive hearing loss. 4) Acute, chronic, or recurrent episodes of dizziness. 5) Evidence of congenital or traumatic deformity of the ear. 6) Visualization of blood, pus, cerumen plug, or foreign body in the ear canal. 7) Conductive hearing loss or abnormal tympanogram.

8) Unilateral or asymmetric hearing loss; or bilateral hearing loss > 80 dB. 9) Unilateral or pulsatile tinnitus. 10) Unilateral or asymmetrically poor speech discrimination scores. The red flags do not include all indications for a medical referral and are not intended to replace clinical judgment in determining the need for consultation with an otolaryngologist.

21 C.F.R. Section 801.420: A hearing aid dispenser should advise a prospective hearing aid user to consult promptly with a licensed physician (preferably an ear specialist) before dispensing a hearing aid if the hearing aid dispenser determines through inquiry, actual observation, or review of any other available information concerning the prospective user, that the prospective user has any of the following conditions: 1) Visible congenital or traumatic deformity of the ear.

2) History of active drainage from the ear within the previous 90 days. 3) History of sudden or rapidly progressive hearing loss within the previous 90 days. 4) Acute or chronic dizziness. 5) Unilateral hearing loss of sudden or recent onset within the previous 90 days. 6) Audiometric air-bone gap equal to or greater than 15 decibels at 500 hertz (Hz), 1,000 Hz, and 2,000 Hz.

7) Visible evidence of significant cerumen accumulation or a foreign body in the ear canal. 8) Pain or discomfort in the ear.

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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