Measure ID: MIPS 463|Anesthesiology|2026 Performance Year

2026 MIPS Measure #463: Prevention of Post-Operative Vomiting (POV) – Combination Therapy (Pediatrics)

Percentage of patients aged 3 through 17 years, who undergo a procedure under general anesthesia in which an inhalational anesthetic is used for maintenance AND who have two or more risk factors for post-operative vomiting (POV), who receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively.

Process – High PriorityAnesthesiologyPediatrics
Measure ID:MIPS 463 (Quality ID 463)
Collection:MIPS CQM
Topped Out:Yes
View CMS Spec ↗

Measure Specification

Eligible Population
Patients aged 3 through 17 years on date of service
ANDPatient procedure during the performance period
ANDPatient received inhalational anesthetic agent: 4554F
ANDPatient exhibits 2 or more risk factors for post-operative vomiting: G9954
Exclusions
G9955Cases in which an inhalational anesthetic is used only for induction
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:

G9956Patient received combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively

Performance Not Met:

G9958Patient did not receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively

○ Exceptions:

G9957Documentation of medical reason for not receiving combination therapy consisting of at least two 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

Young children undergoing general anesthesia often experience post-operative vomiting, especially those with risk factors like history of motion sickness or certain surgery types. This pediatric measure checks whether high-risk kids receive combination anti-emetic therapy (two different drug classes) before or during surgery. Prevention is far better than treating established vomiting—it's uncomfortable and can delay discharge.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 463 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 and has demonstrated effective prophylactic regimes based on these risk factors and demonstrated high variability in this outcome across individual centers and providers.

Between 62-73% of children experience POV when prophylactic anti-emetics are not administered. Beyond the discomfort associated with the condition, POV is a comorbidity which can cause significant postoperative complications, including dehydration and postoperative bleeding. In several studies, incidence of POV decreased significantly in children receiving combination therapy compared to control groups not receiving combination therapy for POV.

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. A separate measure is needed for pediatric patients because the risk factors and recommended prophylaxis are different from adults.

Clinical Recommendations

Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting; Society for Ambulatory Anesthesia (SAMBA), 2020 Administer prophylactic antiemetic therapy to children at increased risk for POV; as in adults, use of combination therapy is most effective. All prophylaxis in children at moderate or high risk for POV should include combination therapy using a 5-HT3 antagonist and a second drug.

Because the effects of interventions from different drug classes are additive, combining interventions has an additive effect in risk reduction.

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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