Who is eligible for MIPS 421?

All patients who have a retrievable IVC filter placed with the intent for potential removal at time of placement.

Is MIPS 421 the same as MIPS 421?

Yes. CMS uses zero-padded three-digit Quality IDs (421) in official specifications, while clinicians often search for MIPS 421 or Quality ID 421 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 421 in 2026?

MIPS Measure 421 (Quality ID 421) 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 421 a topped-out measure?

No, MIPS 421 is not topped out, meaning there is still meaningful performance variation across clinicians.

Measure ID: MIPS 421|Vascular Access|2026 Performance Year

2026 MIPS Measure #421: Appropriate Assessment of Retrievable Inferior Vena Cava (IVC) Filters for Removal

Percentage of patients in whom a retrievable IVC filter is placed who, within 3 months post-placement, have a documented assessment for the appropriateness of continued filtration, device removal, or the inability to contact the patient with at least two attempts.

ProcessVascular AccessAppropriate Use

Measure ID:MIPS 421 (Quality ID 421)

Collection:MIPS CQM

Topped Out:No

View CMS Spec ↗

Measure Specification

Eligible Population

All patients, regardless of age

ANDPatient procedure during the performance period

ANDIntent for Potential Removal at Time of Placement: G9539

ANDPatient alive 3 Months Post Procedure: G9540

Exclusions

None

Numerator

Number of patients that have appropriate IVC filter follow-up.

Reporting Codes

Performance Met:

G9541Filter removed within 3 months of placement

G9542Documented re-assessment for the appropriateness of filter removal within 3 months of placement

G9543Documentation of at least two attempts to reach the patient to arrange a clinical re-assessment for the appropriateness of filter removal within 3 months of placement

Performance Not Met:

G9544Patients that do not have the filter removed, documented re-assessment for the appropriateness of filter removal, or documentation of at least two attempts to reach the patient to arrange a clinical re-assessment for the appropriateness of filter removal within 3 months of placement

VBCA Insights

Why This Measure Matters

Retrievable IVC filters are placed temporarily to prevent blood clots, but they need to be removed once they're no longer needed because they carry long-term risks. This measure ensures you're documenting a reassessment within 3 months of placement and either removing the filter or clearly explaining why it must stay. Set up a system to flag these patients for follow-up—it's easy to lose track of temporary devices, and unintended permanent placement is a patient safety issue.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 421 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

Interventional Radiology

Related Measures

Vascular Access

MIPS 482: Hemodialysis Vascular Access: Practitioner Level Long-term Catheter Rate

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 406: Appropriate Follow-up Imaging for Incidental Thyroid Nodules in Patients MIPS 416: Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt

Official Resources

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

Clinical Rationale

There is a need for increased physician awareness of the potential harms of inappropriate continued inferior vena cava filtration in patients with retrievable filters. Patients with retrievable inferior filters need to be carefully followed for re- assessment of the clinical need for continued inferior vena cava filtration, leading to removal of such devices when clinically appropriate.

Complexities of our healthcare system, notably the use of inferior vena cava filters in the in-patient setting, followed by transfer of care to physicians in the outpatient setting highlight the importance of patient follow-up for physicians placing retrievable inferior vena cava filters.

Clinical Recommendations

Retrievable filter complications have been increasingly noted in the FDA MAUDE database and in the literature. Retrievable filters were designed differently than permanent filters and the incidence of device related complications with long term insertions are higher than in comparison to permanent filters. The FDA has recommended that physicians that place these filters carefully monitor these patients and remove these filters at the earliest possible time.

Dedicated follow-up for IVC filters has led to an increase in retrieval rate. The FDA recommends that all physicians placing IVC Filters and those responsible for ongoing care of these patients remove the filter as soon as protection from pulmonary embolism is no longer needed. The FDA encourages follow-up on patients to consider risks and benefits of filter removal (1).

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. There is no diagnosis associated with this measure. Include only patients that have IVC filter placement through September 30 of the performance period.

This will allow the evaluation of at least 90 days of IVC filter removal within the performance period.

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