Measure ID: MIPS 448·Gynecology·2026 Performance Year

2026 MIPS Measure #448: 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

Measure ID:MIPS 448 (Quality ID 448)

Collection:MIPS CQM

Topped Out:No

View CMS Spec ↗

Measure Specification

Eligible Population

All patients aged 18 years and older on date of encounter

ANDEndometrial ablation during the performance period (ICD-10-PCS)

Exclusions

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.

Reporting Codes

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

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.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 448 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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Your Performance Rate:%Benchmarks vary by collection type

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2026 MIPS 448 Benchmarks

Historical CMS benchmark deciles for MIPS quality measure 448 by collection type. Your performance rate falls into a decile, which determines your measure points (3–10).

MIPS CQM

Decile	Performance Rate Range	Points

Specialty Measure Sets

Obstetrics/Gynecology

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Official Resources

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

Clinical Context

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.

Frequently Asked Questions

Who is eligible for MIPS 448?

All patients aged 18 years and older who undergo an endometrial ablation procedure during the performance period. Definition: Index Date – Date of first endometrial ablation during the performance period

Is MIPS 448 the same as MIPS 448?

Yes. CMS uses zero-padded three-digit Quality IDs (448) in official specifications, while clinicians often search for MIPS 448 or Quality ID 448 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 448: Appropriate Workup Prior to Endometrial Ablation?

Submission codes: G9823 (Endometrial 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); G9824 (Endometrial 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)

How do I report MIPS Measure 448 in 2026?

MIPS Measure 448 (Quality ID 448) 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 448 a topped-out measure?

No, MIPS 448 is not topped out, meaning there is still meaningful performance variation across clinicians.

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