Measure ID: MIPS 422·Gynecology·2026 Performance Year

2026 MIPS Measure #422: Performing Cystoscopy at the Time of Hysterectomy for Pelvic Organ Prolapse to Detect Lower Urinary Tract Injury

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

Measure ID:MIPS 422 (Quality ID 422)

CBE:2063

Collection:MIPS CQM, Part B Claims

Topped Out:No

View CMS Spec ↗

Measure Specification

Eligible Population

All patients, regardless of age

ANDDiagnosis for Pelvic Organ Prolapse

ANDPatient procedure during the performance period

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.

Reporting Codes

Performance Met:

G9606Intraoperative cystoscopy performed to evaluate for lower tract injury

Performance Not Met:

G9608Intraoperative cystoscopy not performed to evaluate for lower tract injury

○ Exceptions:

G9607Documented 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

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.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) and can submit MIPS Measure 422 to the Quality Payment Program (QPP) as a MIPS Clinical Quality Measure (CQM). CMS lists these 2026 collection types for the measure: MIPS CQM and Medicare Part B Claims.

MIPS Score Simulator

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Your Performance Rate:%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.

2026 MIPS 422 Benchmarks

Historical CMS benchmark deciles for MIPS quality measure 422 by collection type. Your performance rate falls into a decile, which determines your measure points (3–10).

MIPS CQM

Decile	Performance Rate Range	Points

Medicare Part B Claims

Decile	Performance Rate Range	Points

Specialty Measure Sets

Obstetrics/Gynecology

Related Measures

Gynecology

MIPS 432: Proportion of Patients Sustaining a Bladder or Bowel Injury at the time of any Pelvic Organ Prolapse Repair MIPS 448: Appropriate Workup Prior to Endometrial Ablation

Patient Safety

MIPS 130: Documentation of Current Medications in the Medical Record MIPS 145: Radiology: Exposure Dose Indices Reported for Procedures Using Fluoroscopy MIPS 155: Falls: Plan of Care MIPS 164: Coronary Artery Bypass Graft (CABG): Prolonged Intubation MIPS 168: Coronary Artery Bypass Graft (CABG): Surgical Re-Exploration MIPS 181: Elder Maltreatment Screen and Follow-Up Plan MIPS 259: Rate of Endovascular Aneurysm Repair (EVAR) of Small or Moderate Non-Ruptured Infrarenal Abdominal Aortic Aneurysms (AAA) without Major Complications (Discharged to Home by Post-Operative Day #2)MIPS 275: Inflammatory Bowel Disease (IBD): Assessment of Hepatitis B Virus (HBV) Status Before Initiating Anti-TNF (Tumor Necrosis Factor) Therapy MIPS 286: Dementia: Safety Concern Screening and Follow-Up for Patients with Dementia MIPS 351: Total Knee or Hip Replacement: Venous Thromboembolic and Cardiovascular Risk Evaluation MIPS 354: Anastomotic Leak Intervention MIPS 355: Unplanned Reoperation within the 30-Day Postoperative Period MIPS 357: Surgical Site Infection (SSI)MIPS 374: Closing the Referral Loop: Receipt of Specialist Report MIPS 384: Adult Primary Rhegmatogenous Retinal Detachment Surgery: No Return to the Operating Room Within 90 Days of Surgery MIPS 385: Adult Primary Rhegmatogenous Retinal Detachment Surgery: Visual Acuity Improvement Within 90 Days of Surgery MIPS 392: Cardiac Tamponade and/or Pericardiocentesis Following Atrial Fibrillation Ablation MIPS 393: Infection within 180 Days of Cardiac Implantable Electronic Device (CIED) Implantation, Replacement, or Revision MIPS 413: Door to Puncture Time for Endovascular Stroke Treatment MIPS 432: Proportion of Patients Sustaining a Bladder or Bowel Injury at the time of any Pelvic Organ Prolapse Repair MIPS 513: Patient Reported Falls and Plan of Care

Urology

MIPS 048: Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older MIPS 050: Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older MIPS 102: Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients MIPS 250: Radical Prostatectomy Pathology Reporting MIPS 432: Proportion of Patients Sustaining a Bladder or Bowel Injury at the time of any Pelvic Organ Prolapse Repair

Official Resources

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

Clinical Context

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.

Frequently Asked Questions

Who is eligible for MIPS 422?

All patients undergoing hysterectomy for pelvic organ prolapse.

Is MIPS 422 the same as MIPS 422?

Yes. CMS uses zero-padded three-digit Quality IDs (422) in official specifications, while clinicians often search for MIPS 422 or Quality ID 422 without the leading zero. Both refer to the same 2026 MIPS quality measure reported through the Quality Payment Program (QPP).

What codes do I submit for MIPS 422: Performing Cystoscopy at the Time of Hysterectomy for Pelvic Organ Prolapse to Detect Lower Urinary Tract Injury?

Submission codes: G9606 (Intraoperative cystoscopy performed to evaluate for lower tract injury); G9608 (Intraoperative cystoscopy not performed to evaluate for lower tract injury)

What is the NQF number for MIPS Measure 422?

MIPS Measure 422 is associated with CBE/NQF number 2063.

How do I report MIPS Measure 422 in 2026?

For the 2026 performance year, CMS lists 2 collection types for MIPS Measure 422 (Quality ID 422): MIPS CQM and Medicare Part B Claims. MIPS CQMs are submitted through a qualified registry or QCDR. Medicare Part B claims reporting is limited to clinicians in small practices.

Is MIPS 422 a topped-out measure?

No, MIPS 422 is not topped out, meaning there is still meaningful performance variation across clinicians.

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