Who is eligible for MIPS 406?

All final reports for CT, CTA, MRI or MRA studies of the chest or neck for patients aged 18 and older with an incidentally- detected thyroid nodule < 1.0 cm noted.

Is MIPS 406 the same as MIPS 406?

Yes. CMS uses zero-padded three-digit Quality IDs (406) in official specifications, while clinicians often search for MIPS 406 or Quality ID 406 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 406 in 2026?

MIPS Measure 406 (Quality ID 406) 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 406 a topped-out measure?

Yes, MIPS 406 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 406|Appropriate Use|2026 Performance Year

2026 MIPS Measure #406: Appropriate Follow-up Imaging for Incidental Thyroid Nodules in Patients

Percentage of final reports for computed tomography (CT), CT angiography (CTA) or magnetic resonance imaging (MRI) or magnetic resonance angiogram (MRA) studies of the chest or neck for patients aged 18 years and older with no known thyroid disease with a thyroid nodule < 1.0 cm noted incidentally with follow-up imaging recommended.

Process – High PriorityAppropriate UseImagingRadiology

Measure ID:MIPS 406 (Quality ID 406)

Collection:MIPS CQM, Part B Claims

Topped Out:Yes

View CMS Spec ↗

Measure Specification

Eligible Population

Patients aged ≥ 18 years on date of encounter

ANDPatient procedure during the performance period

ANDIncidental Thyroid Nodule < 1.0 cm noted in report: G9552

Exclusions

None

Numerator

Final reports for CT, CTA, MRI or MRA of the chest or neck with follow-up imaging recommended for reports with an incidentally-detected thyroid nodule < 1.0 cm noted.

Reporting Codes

Performance Met:

G9554Final reports for CT, CTA, MRI or MRA of the chest or neck with follow-up imaging recommended

Performance Not Met:

G9556Final reports for CT, CTA, MRI or MRA of the chest or neck with follow-up imaging not recommended

○ Exceptions:

G9555Documentation of medical reason(s) for recommending follow- up imaging (e.g., patient has multiple endocrine neoplasia, patient has cervical lymphadenopathy, other medical reason(s))

VBCA Insights

Why This Measure Matters

Small thyroid nodules (<1.0 cm) found incidentally on chest/neck CT or MRI are often benign and rarely need follow-up ultrasound or biopsy. This inverse measure flags unnecessary recommendations for thyroid follow-up imaging. High performance means your radiologists confidently document small nodules and recommend no follow-up (rather than reflexively ordering thyroid ultrasound). Avoiding reflexive follow-up prevents thyroid-specific anxiety, unnecessary biopsies, and downstream cascade testing.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 406 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

Diagnostic Radiology

Related Measures

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 261: Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness 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 416: Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt MIPS 421: Appropriate Assessment of Retrievable Inferior Vena Cava (IVC) Filters for Removal

Imaging

MIPS 145: Radiology: Exposure Dose Indices Reported for Procedures Using Fluoroscopy 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 415: Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt

Radiology

MIPS 145: Radiology: Exposure Dose Indices Reported for Procedures Using Fluoroscopy MIPS 360: Optimizing Patient Exposure to Ionizing Radiation: Count of Potential High Dose

Official Resources

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

Clinical Rationale

Thyroid nodules are common, with estimates of prevalence as high as 50%. Desser and Kamaya found that the majority of incidentally noted thyroid nodules were benign with approximately 5% being malignant. Due to the common nature of small thyroid nodules combined with the low malignancy, nonpalpable nodules detected on US or other anatomic imaging studies are termed incidentally discovered nodules or ‘‘incidentalomas.

’’ Nonpalpable nodules have the same risk of malignancy as palpable nodules with the same size. Generally, only nodules >1 cm should be evaluated, since they have a greater potential to be clinically significant cancers.

Clinical Recommendations

In patients <35 years with an incidental thyroid nodule (ITN) detected on CT, MRI, or extrathyroidal ultrasound, the Committee recommends further evaluation with dedicated thyroid ultrasound if the nodule is ≥1 cm and has no suspicious imaging features, and if the patient has normal life expectancy. In patients ≥35 years with an ITN detected on CT, MRI, or extrathyroidal ultrasound, the Committee recommends further evaluation with dedicated thyroid ultrasound if the nodule is ≥1.

5 cm and has no suspicious imaging features, and if the patient has normal life expectancy.

Implementation Notes

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. Implementation Considerations For the purposes of MIPS implementation, this procedure measure is submitted each time a procedure is performed during the performance period. This is an inverse measure which means a lower calculated performance rate for this measure indicates better clinical care or control.

The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.

Telehealth: NOT TELEHEALTH ELIGIBLE: This measure is not appropriate for nor applicable to the telehealth setting. This measure is procedure based and therefore doesn’t allow for the denominator criteria to be conducted via telehealth. It would be appropriate to remove these patients from the denominator eligible patient population. Telehealth eligibility is at the measure level for inclusion within the denominator eligible patient population and based on the measure specification definitions which are independent of changes to coding and/or billing practices.

Measure Submission: The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this collection type for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. The coding provided to identify the measure criteria: Denominator or Numerator, may be an example of coding that could be used to identify patients that meet the intent of this clinical topic.

When implementing this measure, please refer to the ‘Reference Coding’ section to determine if other codes or code languages that meet the intent of the criteria may also be used within the medical record to identify and/or assess patients. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

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