Is MIPS 395 the same as MIPS 395?

Yes. CMS uses zero-padded three-digit Quality IDs (395) in official specifications, while clinicians often search for MIPS 395 or Quality ID 395 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 395: Lung Cancer Reporting (Biopsy/Cytology Specimens)?

Submission codes: G9418 (Primary non-small cell lung cancer lung biopsy and cytology specimen report documents classification into specific histologic type following IASLC guidance OR classified as NSCLC- NOS with an explanation); G9421 (Primary non-small cell lung cancer lung biopsy and cytology specimen report does not document classification into specific histologic type OR histologic type does not follow IASLC guidance OR is classified as NSCLC-NOS but without an explanation)

How do I report MIPS Measure 395 in 2026?

MIPS Measure 395 (Quality ID 395) 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 395 a topped-out measure?

Yes, MIPS 395 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 395|Oncology|2026 Performance Year

2026 MIPS Measure #395: Lung Cancer Reporting (Biopsy/Cytology Specimens)

Pathology reports based on lung biopsy and/or cytology specimens with a diagnosis of primary non-small cell lung cancer classified into specific histologic type following the International Association for the Study of Lung Cancer (IASLC) guidance or classified as non-small cell lung cancer not otherwise specified (NSCLC-NOS) with an explanation included in the pathology report.

Process – High PriorityOncologyGenomics

Measure ID:MIPS 395 (Quality ID 395)

Collection:MIPS CQM, Part B Claims

Topped Out:Yes

View CMS Spec ↗

Measure Specification

Eligible Population

Patients ≥ 18 years of age on date of service

ANDDiagnosis for lung cancer.

ANDPatient procedure during performance period

Exclusions

G9420Specimen site other than anatomic location of lung or is not classified as primary non-small cell lung cancer

Numerator

Lung biopsy and cytology specimen reports with a diagnosis of primary non-small cell lung cancer classified into specific histologic type following IASLC guidance (see below) (including but not limited to squamous cell carcinoma or adenocarcinoma) OR classified as NSCLC-NOS with an explanation included in the pathology report. IASLC Guidance: The IASLC recommends the following regarding terminology for small biopsy and cytology specimens: 1. Do not use the term “large cell carcinoma” 2. Do not use the term “AIS (adenocarcinoma in situ)” or “MIA (minimally invasive adenocarcinoma)”—if a noninvasive pattern is present in a small biopsy, the term “lepidic growth” should be used instead 3. Do not use the term “BAC (bronchioloalveolar carcinoma)” All three recommendations must be followed in order for a case to be considered Met (i.e., if any one of these terms is present, the case is Not Met)

Reporting Codes

Performance Met:

G9418Primary non-small cell lung cancer lung biopsy and cytology specimen report documents classification into specific histologic type following IASLC guidance OR classified as NSCLC- NOS with an explanation

Performance Not Met:

G9421Primary non-small cell lung cancer lung biopsy and cytology specimen report does not document classification into specific histologic type OR histologic type does not follow IASLC guidance OR is classified as NSCLC-NOS but without an explanation

○ Exceptions:

G9419Documentation of medical reason(s) for not including the histological type OR NSCLC-NOS classification with an explanation (e.g. Specimen insufficient or non-diagnostic, specimen does not contain cancer, or other documented medical reasons)

VBCA Insights

Why This Measure Matters

Lung cancer pathology reports from biopsies or cytology should classify the tumor into a specific histologic type (adenocarcinoma, squamous cell, etc.) or explain why it can't be (e.g., insufficient sample). Precise classification guides molecular testing and therapy selection—adenocarcinoma is tested for EGFR/ALK, squamous cell is not. Poor or nonspecific reporting ('NSCLC-NOS') delays treatment and leaves molecular testing incomplete. Your pathologists' precision here directly impacts whether patients get the right targeted therapy.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 395 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

Related Measures

Oncology

MIPS 102: Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate MIPS 143: Oncology: Medical and Radiation – Pain Intensity Quantified MIPS 144: Oncology: Medical and Radiation – Plan of Care for Pain MIPS 249: Barrett’s Esophagus MIPS 250: Radical Prostatectomy Pathology Reporting MIPS 396: Lung Cancer Reporting (Resection Specimens)MIPS 397: Melanoma Reporting MIPS 401: Hepatitis C: Screening for Hepatocellular Carcinoma (HCC) in Patients with Cirrhosis MIPS 450: Appropriate Treatment for Patients with Stage I (T1c) – III HER2 Positive MIPS 453: Percentage of Patients who Died from Cancer Receiving Systemic Cancer-Directed MIPS 457: Percentage of Patients who Died from Cancer Admitted to Hospice for Less than 3 MIPS 490: Appropriate Intervention of Immune-Related Diarrhea and/or Colitis in Patients Treated MIPS 491: Mismatch Repair (MMR) or Microsatellite Instability (MSI) Biomarker Testing MIPS 506: Positive PD-L1 Biomarker Expression Test Result Prior to First-Line Immune Checkpoint MIPS 507: Appropriate Germline Testing for Ovarian Cancer Patients MIPS 509: Melanoma: Tracking and Evaluation of Recurrence

Genomics

MIPS 396: Lung Cancer Reporting (Resection Specimens)MIPS 451: RAS (KRAS and NRAS) Gene Mutation Testing Performed for Patients with MIPS 491: Mismatch Repair (MMR) or Microsatellite Instability (MSI) Biomarker Testing MIPS 507: Appropriate Germline Testing for Ovarian Cancer Patients

Official Resources

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

Clinical Rationale

Lung cancer is the most frequent cause of major cancer incidence and mortality worldwide. The classifications of lung cancer published by the World Health Organization (WHO) in 1967, 1981, and 1999 were written primarily by pathologists for pathologists. Only in the 2004 revision, relevant genetics and clinical information were introduced. Nevertheless, because of remarkable advances over the last 6 years in our understanding of lung adenocarcinoma, particularly in the area of medical oncology, molecular biology, and radiology, there is a pressing need for a revised classification, based not on pathology alone, but rather on an integrated multidisciplinary platform.

For the first time, this classification addresses an approach to small biopsies and cytology in lung cancer diagnosis. Recent data regarding epidermal growth factor receptor (EGFR) mutation predicting responsiveness to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), toxicities, and therapeutic efficacy have established the importance of distinguishing squamous cell carcinoma from adenocarcinoma and non-small cell lung carcinoma (NSCLC) not otherwise specified (NOS) in patients with advanced lung cancer.

Approximately 70% of lung cancers are diagnosed and staged by small biopsies or cytology rather than surgical resection specimens, with increasing use of transbronchial needle aspiration (TBNA), endobronchial ultrasound-guided TBNA and esophageal ultrasound-guided needle aspiration. Within the NSCLC group, most pathologists can identify well- or moderately-differentiated squamous cell carcinomas or adenocarcinomas, but specific diagnoses are more difficult with poorly differentiated tumors.

Nevertheless, in small biopsies and/or cytology specimens, upwards of 30% of specimens continue to be diagnosed as NSCLC-NOS. Consistent with most current recommendations, including the recent 2021 WHO paper, it is recommended pathologists “reduce use of the term NSCLC NOS as much as possible and classify tumors according to their specific histologic subtype.

”.

Clinical Recommendations

To address advances in oncology, molecular biology, pathology, radiology, and surgery of lung adenocarcinoma, an international multidisciplinary classification was sponsored by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society. This new adenocarcinoma classification is needed to provide uniform terminology and diagnostic criteria, especially for bronchioloalveolar carcinoma (BAC), the overall approach to small non-resection cancer specimens, and for multidisciplinary strategic management of tissue for molecular and immunohistochemical studies.

For small biopsies and cytology, we recommend that NSCLC be further classified into a more specific histologic type, such as adenocarcinoma or squamous cell carcinoma, whenever possible (strong recommendation, moderate quality evidence). The terms AIS or MIA should not be used in small biopsies or cytology specimens. If a noninvasive pattern is present in a small biopsy, it should be referred to as lepidic growth The term large cell carcinoma should not be used for diagnosis in small biopsy or cytology specimens and should be restricted to resection specimens where the tumor is thoroughly sampled to exclude a differentiated component.

We recommend discontinuing the use of the term “BAC” We recommend that the term NSCLC-NOS be used as little as possible and we recommend it be applied only when a more specific diagnosis is not possible by morphology and/or special stains (strong recommendation, moderate quality evidence). The above strategy for classification of adenocarcinoma versus other histologies and the terminology should be used in routine diagnosis and future research and clinical trials so that there is uniform classification of disease cohorts in relationship to tumor subtypes.

Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Classification of Lung Adenocarcinoma. Journal of Thoracic Oncology 2011; 6:244-285.

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) per date of service for a patient is required.

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