Measure ID: MIPS 450·Breast Cancer·2026 Performance Year

2026 MIPS Measure #450: Appropriate Treatment for Patients with Stage I (T1c) – III HER2 Positive

Percentage of patients aged 18 to 70 with stage I (T1c) – III HER2 positive breast cancer for whom appropriate treatment is initiated.

Process – High PriorityBreast CancerOncology
Measure ID:MIPS 450 (Quality ID 450)
CBE:1858
Collection:MIPS CQM
Topped Out:Yes
View CMS Spec ↗

Measure Specification

Eligible Population
Patients age 18-70 years on date of encounter
ANDDiagnosis of breast cancer between July 1st of the previous performance period through June 30th of the current performance period
ANDAt least two patient encounters during the current performance period
WITHOUTEncounters conducted via telehealth: M1426
ANDHER-2/neu positive: G9830
ANDAJCC stage at breast cancer diagnosis = II or III: G9831
ORAJCC stage at breast cancer diagnosis = I (IA or IB) and T-Stage at breast cancer diagnosis = T1c: G9832
Exclusions
G2205Patients with pregnancy during adjuvant treatment course
Numerator
Patients whose adjuvant treatment course includes both chemotherapy and HER2-targeted therapy. _NUMERATOR NOTE:_ The quality action of this measure is the appropriateness of treatment rather than timeliness of treatment. The timing of administration of HER2-targeted therapies is expected to vary depending on the cytotoxic agents used. The numerator statement is intended to capture an adjuvant treatment course that includes both chemotherapy and HER2-targeted therapy, independent of possible administration sequences. The timeframe to identify the adjuvant treatment course is within six months of breast cancer pathologic staging. To satisfy the numerator, both chemotherapy and HER2-targeted therapy must occur within six months of pathologic staging. An FDA-approved trastuzumab biosimilar is an appropriate substitute for trastuzumab.
Reporting Codes

Performance Met:

G2206Patient received adjuvant treatment course including both chemotherapy and HER2-targeted therapy

Performance Not Met:

G2208Patient did not receive adjuvant treatment course including both chemotherapy and HER2-targeted therapy

○ Exceptions:

G2207Reason for not administering adjuvant treatment course including both chemotherapy and HER2-targeted therapy (e.g. poor performance status (ECOG 3-4; Karnofsky ≤50), cardiac contraindications, insufficient renal function, insufficient hepatic function, other active or secondary cancer diagnoses, other medical contraindications, patients who died during initial treatment course or transferred during or after initial treatment course)
VBCA Insights

Why This Measure Matters

HER2-positive breast cancers are aggressive but highly responsive to targeted therapies like trastuzumab when combined with chemotherapy. This measure confirms that patients aged 18–70 with stage I–III HER2-positive disease receive both agents during their adjuvant (post-surgery) treatment course. Omitting HER2-targeted therapy is leaving significant survival benefit on the table—make sure it's part of the plan from the start.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 450 to the Quality Payment Program (QPP). Practices can report this measure as a MIPS Clinical Quality Measure (CQM) or through qualified registry submission.

🧮MIPS Score Simulator

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%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 450 Benchmarks

Historical CMS benchmark deciles for MIPS quality measure 450 by collection type. Your performance rate falls into a decile, which determines your measure points (3–10).

MIPS CQMAvg. performance rate: 92.89%Topped Out
DecilePerformance Rate RangePoints
Decile 142.86 - 80.42%1 – 1.9
Decile 280.43 - 85.15%2 – 2.9
Decile 385.16 - 89.99%3 – 3.9
Decile 490.00 - 95.44%4 – 4.9
Decile 595.45 - 98.79%5 – 5.9
Decile 698.80 - 99.99%6 – 6.9
Decile 10100.00%10

Specialty Measure Sets

Oncology/Hematology

Related Measures

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Clinical Context

Clinical Rationale

Approximately 10-20 percent of patients with breast cancer have tumors that overexpress the human epidermal growth factor receptor (HER2) protein (Early Breast Cancer Trialists' Collaborative group (EBCTCG), 2021). High levels of the HER2 protein are linked with a higher likelihood of metastasis, increased risk of disease recurrence, and a decrease in patient survival, but are more likely to respond to targeted therapies (Early Breast Cancer Trialists' Collaborative group (EBCTCG), 2021) &.

Numerous adjuvant trials of trastuzumab have demonstrated clinically significant improvements in disease-free survival, with the HERA, NSABP B31, and NCCTGF N9831 trials also demonstrating significant improvement in overall survival with the use of trastuzumab. The benefits of trastuzumab are independent of estrogen receptor (ER) status. The American Society of Clinical Oncology (ASCO) envisions that use of this measure will improve concordance with recommendations for the use of HER2-targeted therapy with chemotherapy for patients with stage I (T1c) – III, HER2 positive breast cancer.

Clinical Recommendations

NCCN Recommendation for Adjuvant HER2-Targeted Therapy The panel recommends HER2-targeted therapy in patients with HER2-positive tumors. The panel has designated use of trastuzumab with chemotherapy as a category 1 recommendation for all HER2 positive tumors >1cm (Gradishar, Moran, Abraham, & al., 2024).

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 patient-process measure is submitted a minimum of once per patient during the performance period.

Frequently Asked Questions

Who is eligible for MIPS 450?

All breast cancer patients aged 18 to 70 with pathologic stage I (T1c) – III HER2 positive breast cancer diagnosed between July 1st of the previous performance period through June 30th of the current performance period. Definitions: Use the 2018 ASCO/CAP guideline definitions (re-affirmed in 2023) to determine HER2 status- HER2 Positive: • If result is IHC 3+ based on circumferential membrane staining that is complete, intense and in >10% of the invasive tumor cells • If result is ISH positive based on: • Single-probe average HER2 copy number ≥ 6.0 signals/cell • Dual-probe HER2/CEP17 ratio ≥ 2. 0 with an average HER2 copy number ≥ 4.0 signals/cell • Dual-probe HER2/CEP17 ratio < 2. 0 with an average HER2 copy number = 6.0 signals/cell HER2 Equivocal: • If result is IHC 2+ based on circumferential membrane staining that is incomplete and/or weak/moderate and within > 10% of the invasive tumor cells • If result is ISH equivocal based on: • Single-probe ISH average HER2 copy number ≥ 4.0 and < 6.0 signals/cell • Dual-probe HER2/CEP17 ratio < 2. 0 with an average HER2 copy number ≥4.0 and < 6.0 signals/cell HER2 Negative: • If result is IHC 1+ based on incomplete membrane staining that is faint/barely perceptible and in > 10% of the invasive tumor cells • If result is IHC 0 based on no staining observed or membrane staining that is incomplete and is faint/barely perceptible and in ≤ 10% of the invasive tumor cells • ISH negative based on: • Single-probe average HER2 copy number < 4.0 signals/cell • Dual-probe HER2/CEP17 ratio < 2. 0 with an average HER2 copy number < 4.0 signals/cell HER2 Indeterminate: Report HER2 test result as indeterminate if technical issues prevent one or both tests (IHC and ISH) from being reported as positive, negative, or equivocal. Conditions may include: • Inadequate specimen handling • Artifacts (crush or edge artifacts) that make interpretation difficult • Analytic testing failure. Denominator Instructions: For the purposes of this measure, only pathologic staging and HER-2 testing performed between July 1st of the previous performance period through June 30th of the current performance period will be included in the denominator of this measure.

Is MIPS 450 the same as MIPS 450?

Yes. CMS uses zero-padded three-digit Quality IDs (450) in official specifications, while clinicians often search for MIPS 450 or Quality ID 450 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 450: Appropriate Treatment for Patients with Stage I (T1c) – III HER2 Positive?

Submission codes: G2206 (Patient received adjuvant treatment course including both chemotherapy and HER2-targeted therapy); G2208 (Patient did not receive adjuvant treatment course including both chemotherapy and HER2-targeted therapy)

What is the NQF number for MIPS Measure 450?

MIPS Measure 450 is associated with CBE/NQF number 1858. It can be reported through the Quality Payment Program (QPP) as a MIPS Clinical Quality Measure (CQM).

How do I report MIPS Measure 450 in 2026?

MIPS Measure 450 (Quality ID 450) 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 450 a topped-out measure?

Yes, MIPS 450 is currently topped out, which means most clinicians perform well on this measure and it may be subject to a 7-point scoring cap.

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