Measure ID: MIPS 448|Gynecology|2026 Performance Year

Appropriate Workup Prior to Endometrial Ablation

Percentage of patients, aged 18 years and older, who undergo endometrial sampling or hysteroscopy with biopsy and results are documented before undergoing an endometrial ablation.

Process - High PriorityGynecologyAppropriate Treatment

Last updated: January 15, 2026

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Measure Specification

Denominator (Eligible Population)

All patients aged 18 years and older on date of encounter
ANDEndometrial ablation during the performance period (ICD-10-PCS)

Denominator Exclusions1

G9822Patients who had an endometrial ablation procedure during the 12 months prior to the index date (exclusive of the index date)

Numerator

Patients who received endometrial sampling or hysteroscopy with biopsy and results were documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation.

Submission Codes (QDCs)

✓ Performance Met
G9823Endometrial sampling or hysteroscopy with biopsy and results documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation
✗ Performance Not Met
G9824Endometrial sampling or hysteroscopy with biopsy and results not documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation

Denominator Exceptions

None — this measure has no denominator exceptions.

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VBCA Insights

💡Why This Measure Matters

Before ablating the endometrium (the tissue lining the uterus) for heavy bleeding, you must first rule out endometrial cancer or other serious pathology with tissue sampling or hysteroscopic visualization. This measure ensures that step happens in the 12 months before ablation. Skipping this workup risks missing cancer, and it's a major reason why guidelines require endometrial assessment—don't skip it even if the patient is in a hurry.

📖Clinical Rationale

Prior to endometrial ablation, abnormal uterine bleeding should be evaluated, including but not limited to endometrial sampling and assessment of the uterine cavity (II-2B) [1]. Abnormal Uterine Bleeding (AUB) is a significant issue for women during their reproductive years, occurring in approximately 10-to 35% of women [2-3]. This condition can result in anemia, limit daily activities and raises concerns about uterine cancer.

Five percent of women between the ages of 30 and 49 will seek medical attention for evaluation of menorrhagia [4-6]. Endometrial Ablation (EA) is a well-established, effective treatment for AUB, and is a less invasive alternative to hysterectomy, with lower complication rates. The procedure effectively reduces menstrual flow and results in high patient satisfaction [7].

Preoperative evaluations include endometrial sampling and assessment of the uterine cavity [7].

📝Clinical Recommendations

The Society of Obstetricians and Gynecologists of Canada published the Clinical Practice Guideline “Endometrial Ablation in the Management of Abnormal Uterine Bleeding in 2015” [1]. This guideline has various recommendations for indication and contraindication and preoperative assessments prior to Endometrial Ablation (EA). Table 2 of the guideline details indications and contraindication to EA.

Indications include: AUB of benign origin, and candidates that are poor surgical candidates for hysterectomy [1]. Absolute contraindications for EA include pregnancy, desire to preserve fertility, endometrial hyperplasia or cancer, cervical cancer, and active pelvic infection [1]. The guideline goes on to recommend: “3. Recommended evaluations for abnormal uterine bleeding, including but not limited to endometrial sampling and an assessment of the uterine cavity are necessary components of the preoperative assessment.

(II-2B) [1].” The guideline then offers clinical tips which list required investigations prior to EA which include: a pregnancy test; Papanicolaou test within 2 years, cervical cultures if clinically appropriate, endometrial sampling; and, assessment of uterine cavity for Mullerian anomalies or intracavity pathology [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.

Measure Details

MIPS 448View CMS Spec ↗
Year2026
TypeProcess
PriorityHigh Priority
InverseNo
Topped OutNo
7-Point CapNo
SubmissionMIPS CQM

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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