Measure ID: MIPS 277|Sleep Medicine|2026 Performance Year

2026 MIPS Measure #277: Sleep Apnea: Severity Assessment at Initial Diagnosis

Percentage of patients aged 18 years and older with a diagnosis of obstructive sleep apnea who had an apnea hypopnea index (AHI), a respiratory disturbance index (RDI), or a respiratory event index (REI) documented or measured within 2 months after initial evaluation for suspected obstructive sleep apnea.

ProcessSleep MedicineAppropriate Use
Measure ID:MIPS 277 (Quality ID 277)
Collection:MIPS CQM
Topped Out:Yes
View CMS Spec ↗

Measure Specification

Eligible Population
Patients aged ≥ 18 years on date of encounter
ANDDiagnosis for sleep apnea on date of encounter
ANDPatient encounter during the performance period
ANDEncounter corresponds to initial diagnosis of sleep apnea or first contact with sleep apnea diagnosed patient: M1441
Exclusions

None

Numerator
Patients who had an apnea hypopnea index (AHI), a respiratory disturbance index (RDI), or a respiratory event index (REI) documented or measured within 2 months after initial evaluation for suspected obstructive sleep apnea
Reporting Codes

Performance Met:

G8842Apnea hypopnea index (AHI), respiratory disturbance index (RDI) or respiratory event index (REI) documented or measured within 2 months after initial evaluation for suspected obstructive sleep apnea

Performance Not Met:

G8844Apnea hypopnea index (AHI), respiratory disturbance index (RDI), or respiratory event index (REI) not documented or measured within 2 months after initial evaluation for suspected obstructive sleep apnea, reason not given

○ Exceptions:

G8843Documentation of reason(s) for not measuring an apnea hypopnea index (AHI), a respiratory disturbance index (RDI), or a respiratory event index (REI) within 2 months after initial evaluation for suspected obstructive sleep apnea (e.g., medical, neurological, or psychiatric disease that prohibits successful completion of a sleep study, patients for whom a sleep study would present a bigger risk than benefit or would pose an undue burden, dementia, patients previously diagnosed with OSA and severity assessed by another provider, patients who decline AHI/RDI/REI measurement, patients who had a financial reason for not completing testing, test was ordered but not completed, patients decline because their insurance (payer) does not cover the expense)
VBCA Insights

Why This Measure Matters

Sleep apnea severity—measured by how many breathing events a patient has per hour (the AHI score)—determines everything about treatment: whether they need CPAP, what pressure setting, or whether surgery might help. This measure ensures you're documenting an objective severity index (AHI, RDI, or REI) within two months of diagnosis. Without that number, you're flying blind on treatment decisions. Get the sleep study results into the record early so you can choose therapy confidently.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 277 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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Related Measures

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Clinical Rationale

The severity of OSA must be established in order to make an appropriate treatment decision. For patients with obstructive sleep apnea (OSA), treatment selection and implementation are dependent on the severity of the disease. Physicians treating patients with OSA should calculate the patient’s level of severity, which informs risk for other co- morbid conditions and complications.

Clinically, the apnea-hypopnea index (AHI) provides cutpoints that can be used to establish the diagnosis and severity of OSA and evaluate treatment effect. OSA severity is graded depending on the AHI. Mild OSA with AHI of 5 to <15, moderate with AHI of 15 to 30 and severe with AHI of >30. Patients with a respiratory disturbance index equal to or greater than 15 are considered to have moderate to severe OSA and should be treated with OSA therapy.

Clinical Recommendations

The Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea recommends that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA (Kapur et al, 2017).

Mild, moderate and severe OSA are defined according to following criteria in adults: mild, RDI 5 to ≤15; moderate, RDI 15 to 30; and severe, RDI >30 (Kushida et al, 2008). Treatment success is usually defined as a reduction in the AHI/RDI/REI to a specific level (e.g., post-treatment AHI/RDI/REI < 5, > 50% reduction in AHI/RDI/ REI) (Ramar et al, 2015).

The severity of OSA is determined by an index – Apnea Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI), if PSG is performed, or Respiratory Event Index (REI) if out-of-center-sleep testing (OCST) is performed (Goyal et al, 2017).

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 episode measure is submitted each time a patient has a denominator eligible encounter during the performance period.

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