Measure ID: MIPS 430|Anesthesiology|2026 Performance Year

2026 MIPS Measure #430: Prevention of Post-Operative Nausea and Vomiting (PONV) – Combination Therapy

Percentage of patients, aged 18 years and older, who undergo a procedure under an inhalational general anesthetic, AND who have three or more risk factors for post-operative nausea and vomiting (PONV), who receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively.

Process – High PriorityAnesthesiologyPatient Experience
Measure ID:MIPS 430 (Quality ID 430)
Collection:MIPS CQM
Topped Out:Yes
View CMS Spec ↗

Measure Specification

Eligible Population
Patients aged ≥ 18 years on date of service
ANDPatient procedure during the performance period
ANDPatient received inhalational anesthetic agent: 4554F
ANDPatient exhibits 3 or more risk factors for post-operative nausea and vomiting: 4556F
Exclusions

None

Numerator
Patients who receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively.
Reporting Codes

Performance Met:

G9775Patient received at least 2 prophylactic pharmacologic anti- emetic agents of different classes preoperatively and/or intraoperatively

Performance Not Met:

G9777Patient did not receive at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively

○ Exceptions:

G9776Documentation of medical reason for not receiving at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (e.g., intolerance or other medical reason)
VBCA Insights

Why This Measure Matters

Post-operative nausea and vomiting (PONV) is one of the most common complaints after surgery, and it significantly worsens patient satisfaction and recovery. This measure flags patients with multiple PONV risk factors (older age, female sex, history of motion sickness, type of surgery) who should receive preventive medications from at least two different drug classes. Using a risk-stratified approach with combination therapy is far more effective than single-agent prevention.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 430 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

Anesthesiology

Clinical Rationale

Postoperative nausea and vomiting (PONV) is an important patient-centered outcome of anesthesia care. PONV is highly dis-satisfying to patients, although rarely life-threatening. A large body of scientific literature has defined risk factors for PONV; demonstrated effective prophylactic regimes based on these risk factors, and demonstrated high variability in this outcome across individual centers and providers.

Further, a number of papers have shown that performance can be assessed at the level of individual providers -- the outcome is common enough that sufficient power exists to assess variability and improvement at this level.

Clinical Recommendations

Practice Guidelines for Postanesthetic Care; American Society of Anesthesiologists, 2013 Anti-emetic agents should be used for the prevention and treatment of nausea and vomiting when indicated. Multiple anti-emetic agents may be used for the prevention and treatment of nausea and vomiting when indicated. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting; Society for Ambulatory Anesthesia (SAMBA), 2020 Administer prophylactic therapy with combination (≥ 2) interventions/multimodal therapy in patients at high risk for PONV.

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.

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