Measure ID: MIPS 398|Asthma|2026 Performance Year

Optimal Asthma Control

Composite measure of the percentage of pediatric and adult patients whose asthma is well-controlled as demonstrated by one of three age appropriate patient reported outcome tools and not at risk for exacerbation.

Outcome – High PriorityAsthmaPreventive CarePulmonology

Last updated: January 15, 2026

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Measure Specification

Denominator (Eligible Population)

Submission Criteria 1
Patients aged 5-17 years
ANDDiagnosis for asthma
ANDPatient had a diagnosis of asthma with any contact during the current or prior performance period OR had asthma present on an active problem list any time during the performance period: M1457
ANDEstablished patient office or telehealth visit during the performance period
Submission Criteria 2
AND NOTPatients aged 18-50 years
ANDDiagnosis for asthma
ANDPatient had a diagnosis of asthma with any contact during the current or prior performance period OR had asthma present on an active problem list any time during the performance period: M1457
ANDEstablished patient office or telehealth visit during the performance period

Denominator Exclusions7

M1460Diagnosis for chronic obstructive pulmonary disease, emphysema, cystic fibrosis, or acute respiratory failure
M1458Patient died prior to the end of the performance period
M1459Patient was in hospice or receiving palliative care services at any time during the performance period
M1021Patient had only urgent care visits during the performance period: M1021
M1458Patient died prior to the end of the performance period
M1459Patient was in hospice or receiving palliative care services at any time during the performance period
M1021Patient had only urgent care visits during the performance period: M1021

Numerator

NUMERATOR (ALL OR NOTHING): The number of asthma patients who meet ALL of the following targets. NUMERATOR (ALL OR NOTHING): The number of asthma patients who meet ALL of the following targets

Submission Codes (QDCs)

✓ Performance Met
G9432Asthma well-controlled based on the ACT, C-ACT, ACQ, or ATAQ score and results documented
G9521Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months
✗ Performance Not Met
G9434Asthma not well-controlled based on the ACT, C-ACT, ACQ, or ATAQ score, OR specified asthma control tool not used, reason not given
G9522Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months OR patient not screened, reason not given

Denominator Exceptions

None — this measure has no denominator exceptions.

🧮MIPS Score Simulator

Estimate only — actual CMS scoring may vary based on reporting method, data completeness, and annual rule updates.

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VBCA Insights

💡Why This Measure Matters

Pediatric and adult asthma patients should achieve 'well-controlled' asthma, meaning minimal symptoms, good lung function, and low exacerbation risk—assessed by tools like the ACT (Asthma Control Test). This all-or-nothing measure rewards comprehensive control: symptom control, medication adherence, regular monitoring, and environmental/trigger management. Poor control often reflects inadequate ICS therapy or patient education; improving it reduces ER visits, hospitalizations, and school/work absences.

📖Clinical Rationale

Roughly 7% of adults and children in Minnesota are currently living with asthma. Asthma is a chronic disease associated with familial, infectious, allergenic, socioeconomic, psychosocial, and environmental factors. It is not curable but is treatable. Despite improvements in diagnosis and management, and an increased understanding of the epidemiology, immunology, and biology of the disease, asthma prevalence has progressively increased over the past 15 years.

📝Clinical Recommendations

From the National Quality Forum’s 2013 report, Patient Reported Outcomes (PROs) in Performance Measurement: Patient and family engagement is increasingly acknowledged as a key component of a comprehensive strategy, (along with performance improvement and accountability), to achieve a high quality, affordable health system. Emerging evidence affirms that patients who are engaged in their care tend to experience better outcomes and choose less costly but effective interventions.

Historically, with the exception of collecting feedback on satisfaction or experience with care, patients remain an untapped resource in assessing the quality of healthcare and of long-term support services. Patients are a valuable and, arguably, the authoritative source of information on outcomes beyond experience with care. These include health-related quality of life, functional status, symptom and symptom burden, and health behaviors.

Patient Reported Outcome Measures (PROMs) are standardized instruments that capture patients’ self-assessment of their health and can provide timely information on patient health status, function, and symptoms over time that can be used to improve patient-centered care and inform clinical decision-making. The Asthma Control TestTM (ACT) is a validated self-administered survey utilizing 5 questions to assess asthma control on a scale from 0 (poor control) to 5 (total control) in individuals 12 years and older.

© 2002 by QualityMetric Incorporated. Asthma Control Test is a trademark of QualityMetric Incorporated. The Childhood Asthma Control Test (C-ACT) is a caregiver-assisted, child-completed tool that can be used with or without lung function assessment to assess pediatric asthma control at home or in clinical practice for children ages 4-11 years. It consists of 7 questions of which 4 are child-reported and 3 are caregiver-reported questions.

©2007 The GlaxoSmithKline Group of Companies. The Asthma Control Questionnaire (ACQ) is a validated, self-administered survey available in various formats from the developer, Elizabeth F. Juniper, MCSP, MSc. Link to ACQ Survey The Asthma Therapy Assessment Questionnaire (ATAQ) is available in a version for adults (18 and over) and a version for children and adolescents (5 – 17).

© 2005 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

📋Implementation Notes

This measure contains two strata defined by two submission criteria. This measure produces seven performance rates. There are 2 Submission Criteria for this measure: 1) Patients aged 5-17 years with well-controlled asthma, without elevated risk of exacerbation OR 2) Patients aged 18-50 years with well-controlled asthma, without elevated risk of exacerbation This measure will be calculated with 7 performance rates: 1) Overall Percentage for patients (aged 5-50 years) with well-controlled asthma, without elevated risk of exacerbation 2) Percentage of pediatric patients (aged 5-17 years) with well-controlled asthma, without elevated risk of exacerbation 3) Percentage of adult patients (aged 18-50 years) with well-controlled asthma, without elevated risk of exacerbation 4) Asthma well-controlled (submit the most recent specified asthma control tool result) for patients 5 to 17 with Asthma 5) Asthma well-controlled (submit the most recent specified asthma control tool result) for patients 18 to 50 with Asthma 6) Patient not at elevated risk of exacerbation for patients 5 to 17 with Asthma 7) Patient not at elevated risk of exacerbation for patients 18 to 50 with Asthma All performance rates must be submitted for this measure.

For accountability reporting in the CMS MIPS program, Performance Rate 1 is used for performance. For the purposes of MIPS implementation, this patient-intermediate measure is submitted a minimum of once per patient for the performance period. The most recent numerator option/quality data code will be used if the measure is submitted more than once.

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© 2002 by QualityMetric Incorporated. ©2007 The © 2005 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. © MN Community Measurement, 2025. All rights reserved.