Measure ID: MIPS 422|Gynecology|2026 Performance Year

Performing Cystoscopy at the Time of Hysterectomy for Pelvic Organ Prolapse

Percentage of patients who undergo cystoscopy to evaluate for lower urinary tract injury at the time of hysterectomy for pelvic organ prolapse.

Process – High PriorityGynecologyPatient SafetyUrology

Last updated: January 15, 2026

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Measure Specification

Denominator (Eligible Population)

All patients, regardless of age
ANDDiagnosis for Pelvic Organ Prolapse
ANDPatient procedure during the performance period
ORDenominator Exception: Documented medical reasons for not performing intraoperative cystoscopy (e.g., urethral pathology precluding cystoscopy, any patient who has a congenital or acquired absence of the urethra) or in the case of patient death (G9607)
ORPerformance Not Met: Intraoperative cystoscopy not performed to evaluate for lower tract injury (G9608)

Denominator Exclusions

None

Numerator

Patients in whom an intraoperative cystoscopy was performed to evaluate for lower urinary tract injury at the time of hysterectomy for pelvic organ prolapse.

Submission Codes (QDCs)

✓ Performance Met
G9606Intraoperative cystoscopy performed to evaluate for lower tract injury
✗ Performance Not Met
G9608Intraoperative cystoscopy not performed to evaluate for lower tract injury

Denominator Exceptions

G9607Denominator Exception: Documented medical reasons for not performing intraoperative cystoscopy (e.g., urethral pathology precluding cystoscopy, any patient who has a congenital or acquired absence of the urethra) or in the case of patient death

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VBCA Insights

💡Why This Measure Matters

During prolapse repair surgery, it's easy to accidentally injure the bladder or ureters because of the complex pelvic anatomy. This measure checks whether you're performing intraoperative cystoscopy to inspect for injuries that can be fixed right away—preventing serious complications and delayed recognition. Universal cystoscopy at the time of surgery catches up to 97% of injuries before the patient leaves the OR. Make it part of your standard closure routine.

📖Clinical Rationale

Lower urinary tract (bladder and/or ureter(s)) injury is a common complication of prolapse repair surgery, occurring in up to 5% of patients. Delay in detection of lower urinary tract injury has an estimated cost of $54, 000 per injury (Visco et al), with significant morbidity for patients who experience them. Universal cystoscopy may detect up to 97% of all injuries at the time of surgery, resulting in the prevention of significant morbidity and providing significant cost savings (over $108 million per year).

There is a gap in the performance of cystoscopy at the time of hysterectomy for pelvic organ prolapse. In a recent study we found that only 84.5% (539/638) of surgeons performed cystoscopy at the time of hysterectomy for pelvic organ prolapse. As many as 97% of high volume surgeons performed a cystoscopy at the time of hysterectomy for pelvic organ prolapse while low volume surgeons performed this procedure only 75 % of the time (p<.

001).

📝Clinical Recommendations

It is strongly recommended to perform cystoscopy at the conclusion of any hysterectomy done for an indication that includes uterovaginal prolapse. The cystoscopy must assess for and document at a minimum the integrity of the bladder as well as patency of the ureters.

📋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 422View CMS Spec ↗
CBE / NQF#2063
Year2026
TypeProcess
PriorityHigh Priority
InverseNo
Topped OutNo
7-Point CapNo
SubmissionMIPS CQM · Medicare Part B Claims

Specialty Sets

CMS-designated specialty sets containing this measure:

Obstetrics/Gynecology (23)

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Official Resources

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

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