Measure ID: MIPS 413|Stroke|2026 Performance Year

Door to Puncture Time for Endovascular Stroke Treatment

Percentage of patients undergoing endovascular stroke treatment who have a door to puncture time of 90 minutes or less.

Intermediate Outcome – High PriorityStrokePatient Safety

Last updated: January 15, 2026

⚙️

Measure Specification

Denominator (Eligible Population)

All patients, regardless of age
ANDDiagnosis for ischemic stroke
ANDPatient procedure during the performance period

Denominator Exclusions3

G9766Patients who are transferred from one institution to another with a known diagnosis of CVA for endovascular stroke treatment
G9767Hospitalized patients with newly diagnosed CVA considered for endovascular stroke treatment
M1381Patients with secondary stroke (e.g., a subsequent stroke that may occur with vasospasm in the setting of subarachnoid hemorrhage) within 5 days of the initial procedure

Numerator

Patients with CVA undergoing endovascular stroke treatment who have a door to puncture time of less than 90 minutes.

Submission Codes (QDCs)

✓ Performance Met
G9580Door to puncture time of 90 minutes or less
✗ Performance Not Met
G9582Door to puncture time of greater than 90 minutes, no reason 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.

%Benchmarks vary by collection type
💡 Tip: Enter your performance rate to compare MIPS points across all collection types. The same rate can score differently depending on how you submit.
VBCA Insights

💡Why This Measure Matters

For acute ischemic stroke patients receiving endovascular thrombectomy, time is brain—door-to-puncture time (arrival to catheter insertion) should be ≤90 minutes. Every minute counts for salvaging brain tissue. This measure reflects institutional efficiency: rapid CT/MRI, quick neuroendovascular team activation, streamlined workflows, and coordination between emergency and interventional teams. Meeting this benchmark requires culture change and systems thinking; achieving it meaningfully improves stroke recovery.

📖Clinical Rationale

Acknowledgment of the critical importance of time to reperfusion for obtaining favorable outcomes in myocardial revascularization has led to the formation of similar initiatives as a measure of effective systems to enable an endovascular treatment program for acute stroke. Multiple hospital systems must interact effectively to enable patients presenting from any location to be assessed clinically and undergo imaging to ascertain if they are candidates for endovascular therapies.

By ensuring a door to puncture time of 90 minutes or less, stroke patients are given the best chance of functional recovery.

📝Clinical Recommendations

This measure is supported by the multispecialty guidelines for intra-arterial catheter directed stroke treatment published in 2013 and updated in 2018 (1, 2, 3).

📋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 procedure measure is submitted each time a procedure is performed during the performance period.

Measure Details

MIPS 413View CMS Spec ↗
Year2026
TypeIntermediate Outcome
PriorityHigh Priority
InverseNo
Topped OutNo
7-Point CapNo
SubmissionMIPS CQM

Specialty Sets

CMS-designated specialty sets containing this measure:

Interventional Radiology (13)Neurosurgical (8)

Related Measures

StrokeMIPS 187

Stroke and Stroke Rehabilitation: Thrombolytic Therapy

Patient SafetyMIPS 130

Documentation of Current Medications in the Medical Record

Patient SafetyMIPS 145

Radiology: Exposure Dose Indices Reported for Procedures Using Fluoroscopy

Patient SafetyMIPS 155

Falls: Plan of Care

Patient SafetyMIPS 164

Coronary Artery Bypass Graft (CABG): Prolonged Intubation

Patient SafetyMIPS 168

Coronary Artery Bypass Graft (CABG): Surgical Re-Exploration

Patient SafetyMIPS 181

Elder Maltreatment Screen and Follow-Up Plan

Patient SafetyMIPS 259

Rate of Endovascular Aneurysm Repair (EVAR) of Small or Moderate Non-Ruptured

Patient SafetyMIPS 275

Inflammatory Bowel Disease (IBD): Assessment of Hepatitis B Virus (HBV) Status Before

Patient SafetyMIPS 286

Dementia: Safety Concern Screening and Follow-Up for Patients with Dementia

Patient SafetyMIPS 351

Total Knee or Hip Replacement: Venous Thromboembolic and Cardiovascular Risk

Patient SafetyMIPS 354

Anastomotic Leak Intervention

Patient SafetyMIPS 355

Unplanned Reoperation within the 30-Day Postoperative Period

Patient SafetyMIPS 357

Surgical Site Infection (SSI)

Patient SafetyMIPS 374

Closing the Referral Loop: Receipt of Specialist Report

Patient SafetyMIPS 384

Adult Primary Rhegmatogenous Retinal Detachment Surgery: No Return to the Operating

Patient SafetyMIPS 385

Adult Primary Rhegmatogenous Retinal Detachment Surgery: Visual Acuity Improvement

Patient SafetyMIPS 392

Cardiac Tamponade and/or Pericardiocentesis Following Atrial Fibrillation

Patient SafetyMIPS 393

Infection within 180 Days of Cardiac Implantable Electronic Device (CIED) Implantation,

Patient SafetyMIPS 422

Performing Cystoscopy at the Time of Hysterectomy for Pelvic Organ Prolapse

Patient SafetyMIPS 432

Proportion of Patients Sustaining a Bladder or Bowel Injury at the time of any Pelvic

Patient SafetyMIPS 513

Patient Reported Falls and Plan of Care

Official Resources

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

Report this measure through VBCA

Our QCDR handles measure selection, data validation, and submission—so you can focus on clinical performance.

Learn About Our QCDR →
© 2025 Society of Interventional Radiology.