Who is eligible for MIPS 432?

DENOMINATOR (CRITERIA 1): All patients undergoing anterior or apical pelvic organ prolapse (POP) surgery. Definitions: Denominator identification period – the twelve month period in which eligible patients have a procedure, which December 1st of the previous performance period through November 30th of the current performance period. DENOMINATOR (CRITERIA 2): All patients undergoing anterior, posterior, or apical pelvic organ prolapse (POP) surgery. Definitions: Denominator identification period – the twelve month period in which eligible patients have a procedure, which December 1st of the previous performance period through November 30th of the current performance period.

Is MIPS 432 the same as MIPS 432?

Yes. CMS uses zero-padded three-digit Quality IDs (432) in official specifications, while clinicians often search for MIPS 432 or Quality ID 432 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 432 in 2026?

MIPS Measure 432 (Quality ID 432) 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 432 a topped-out measure?

No, MIPS 432 is not topped out, meaning there is still meaningful performance variation across clinicians.

Measure ID: MIPS 432|Gynecology|2026 Performance Year

2026 MIPS Measure #432: Proportion of Patients Sustaining a Bladder or Bowel Injury at the time of any Pelvic

Percentage of patients undergoing surgical repair of pelvic organ prolapse that is complicated by a bladder or bowel injury at the time of index surgery that is recognized intraoperatively or within 30 days after surgery.

Outcome – High PriorityGynecologyPatient SafetyUrology

Measure ID:MIPS 432 (Quality ID 432)

Collection:MIPS CQM

Topped Out:No

View CMS Spec ↗

Measure Specification

This measure produces 2 performance rates. Each rate has its own eligible population, numerator, and reporting codes.

Rate 1

Eligible Population

All patients, regardless of age

ANDPatient procedure during the denominator identification period

Exclusions

None

Numerator

Percentage of patients undergoing prolapse repair who sustain a bladder injury that necessitates repair either intraoperatively or within 30 days after surgery.

Reporting Codes

Performance Met:

G9625Patient sustained bladder injury at the time of surgery or discovered subsequently up to 30 days post-surgery

Performance Not Met:

G9627Patient did not sustain bladder injury at the time of surgery nor discovered subsequently up to 30 days post-surgery

○ Exceptions:

G9626Documented medical reasons for not reporting bladder injury (e.g. gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bladder injury)

Rate 2

Eligible Population

ANDAll patients undergoing anterior, posterior, or apical pelvic organ prolapse (POP) surgery.

ANDPatient procedure during the denominator identification period

Exclusions

None

Reporting Codes

Performance Met:

G9628Patient sustained bowel injury at the time of surgery or discovered subsequently up to 30 days post-surgery

Performance Not Met:

G9630Patient did not sustain a bowel injury at the time of surgery nor discovered subsequently up to 30 days post-surgery

○ Exceptions:

G9629Documented medical reasons for not reporting bowel injury (e.g. gynecologic or other pelvic malignancy documented, planned (e.g. not due to an unexpected bowel injury) resection and/or re-anastomosis of bowel, or patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bowel injury)

VBCA Insights

Why This Measure Matters

Bladder and bowel injuries happen in 0.1–4% of prolapse surgeries depending on the approach, and when injuries go unrecognized, mortality from sepsis can jump from 2% to 23%. This is an inverse measure—lower rates are better, meaning you're catching and fixing injuries in real time. The key is either performing cystoscopy and proctoscopy during the procedure or having a low threshold for imaging and return to the OR if you suspect injury.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 432 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

Obstetrics/Gynecology Urology

Related Measures

Gynecology

MIPS 422: Performing Cystoscopy at the Time of Hysterectomy for Pelvic Organ Prolapse 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 MIPS 275: Inflammatory Bowel Disease (IBD): Assessment of Hepatitis B Virus (HBV) Status Before 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 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 MIPS 385: Adult Primary Rhegmatogenous Retinal Detachment Surgery: Visual Acuity Improvement MIPS 392: Cardiac Tamponade and/or Pericardiocentesis Following Atrial Fibrillation MIPS 393: Infection within 180 Days of Cardiac Implantable Electronic Device (CIED) Implantation,MIPS 413: Door to Puncture Time for Endovascular Stroke Treatment MIPS 422: Performing Cystoscopy at the Time of Hysterectomy for Pelvic Organ Prolapse MIPS 513: Patient Reported Falls and Plan of Care

Urology

MIPS 048: Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in MIPS 050: Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years MIPS 102: Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate MIPS 250: Radical Prostatectomy Pathology Reporting MIPS 422: Performing Cystoscopy at the Time of Hysterectomy for Pelvic Organ Prolapse

Official Resources

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

Clinical Rationale

There are numerous approaches to surgical correction of pelvic organ prolapse- vaginal, open, laparoscopic and robotic. The incidence of visceral injury ranges from 0.1-4%, depending on the approach, with high potential for morbidity. Unrecognized injury to the intestine increases the risk of mortality from 2 to 23% (Chapron et al. J Am Coll Surg. 1991;185:461-465, Baggish, MS J Gynecol Surg.

2003;19:63-73). It is critically important for surgeons who are performing these procedures to recognize and repair any visceral injuries intraoperatively, in order to minimize postoperative morbidity, including the need for subsequent surgical intervention to address these complications. Surgeons benefit from interventions to improve the quality of their surgical care if they have a higher than expected rate of visceral injury during pelvic organ prolapse repair.

Bladder injury is a common and potentially debilitating complication of pelvic surgery but more common in surgery for pelvic organ prolapse. Surgeons may benefit from interventions to improve the quality of their surgical care if they have a higher than expected rate of bladder injury during pelvic organ prolapse repair.

Clinical Recommendations

There are numerous approaches to surgical correction of pelvic organ prolapse- vaginal, open, laparoscopic and robotic. The incidence of visceral injury ranges from 0.1-4% (SGS Systemic Review Obstet Gynecol 2008: 112: 1131- 1142) depending on the approach with high potential for morbidity. Unrecognized injury to the intestine increases the risk of mortality from 2 to 23 %

Implementation Notes

This measure contains two strata defined by two submission criteria. This measure produces two performance rates which are used for a simple average. There are 2 Submission Criteria for this measure: 1) All patients undergoing anterior or apical pelvic organ prolapse (POP) surgery who sustain a bladder injury. AND 2) All patients undergoing anterior, posterior, or apical pelvic organ prolapse (POP) surgery who sustain a bowel injury.

This measure contains two submission criteria which together ensure that the proper evaluation and treatment is provided for patients who undergo pelvic organ prolapse repair. Submission Criteria 1 evaluates whether patients sustained a bladder injury intraoperatively or within 30 days after surgery. Submission Criteria 2 evaluates whether patients sustained a bowel injury intraoperatively or within 30 days after surgery.

Patients who undergo a procedure that meets the denominator of both submission criteria should be included in both and assessed for each clinical outcome. This measure will be calculated with 2 performance rates: 1) Percentage of patients undergoing prolapse repair who sustain a bladder injury that necessitates repair either intraoperatively or within 30 days after surgery.

2) Percentage of patients undergoing prolapse repair who sustain a bowel injury that necessitates repair either intraoperatively or within 30 days after surgery. Submission of the two performance rates is required for this measure. A simple average, which is the sum of the performance rates divided by the number of the performance rates will be used to calculate performance.

For purposes of MIPS implementation, this procedure measure is to be submitted each time a denominator eligible procedure is performed during the denominator identification period. This is an inverse measure which means a lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control.

Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.

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