Who is eligible for MIPS 470?

Patients 18 years of age or older as of October 1 of the denominator identification period who had a total knee replacement procedure performed during the denominator identification period. Definition: Denominator Identification Period – The twelve-month period in which eligible patients have a denominator eligible procedure. This allows for enough time for a follow-up assessment to occur during the twelve-month performance period. The “denominator identification period” includes dates of procedure 10/1/2024 to 9/30/2025.

Is MIPS 470 the same as MIPS 470?

Yes. CMS uses zero-padded three-digit Quality IDs (470) in official specifications, while clinicians often search for MIPS 470 or Quality ID 470 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 470 in 2026?

MIPS Measure 470 (Quality ID 470) 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 470 a topped-out measure?

No, MIPS 470 is not topped out, meaning there is still meaningful performance variation across clinicians.

Measure ID: MIPS 470|Orthopedics|2026 Performance Year

2026 MIPS Measure #470: Functional Status After Primary Total Knee Replacement

For patients age 18 and older who had a primary total knee replacement procedure, functional status is rated by the patient as greater than or equal to 37 on the Oxford Knee Score (OKS) or a 71 or greater on the KOOS, JR. tool at one year (9 to 15 months) postoperatively.

Patient-Reported Outcome-Based Performance Measure – High PriorityOrthopedicsPatient-Reported Outcomes

Measure ID:MIPS 470 (Quality ID 470)

Collection:MIPS CQM

Topped Out:No

View CMS Spec ↗

Measure Specification

Eligible Population

Patients aged ≥ 18 years by October 1 of the Denominator Identification Period

ANDPatient procedure during performance period

Exclusions

None

Numerator

All eligible patients whose functional status is greater than or equal to 37 on the Oxford Knee Score (OKS) or greater than or equal to 71 on the KOOS, JR. patient reported outcome tool at one year (9 to 15 months) postoperatively.

Reporting Codes

Performance Met:

M1045Functional status measured by the Oxford Knee Score (OKS) at one year (9 to 15 months) postoperatively was greater than or equal to 37 or Knee injury and Osteoarthritis Outcome Score Joint Replacement (KOOS, JR.) was greater than or equal to 71

Performance Not Met:

M1141Functional status was not measured by the Oxford Knee Score (OKS) or the Knee injury and Osteoarthritis Outcome Score Joint Replacement (KOOS, JR.) at one year (9 to 15 months) postoperatively

M1046Functional status measured by the Oxford Knee Score (OKS) at one year (9 to 15 months) postoperatively was less than 37 or the Knee injury and Osteoarthritis Outcome Score Joint Replacement (KOOS, JR.) was less than 71 postoperatively

VBCA Insights

Why This Measure Matters

Total knee replacement should meaningfully restore function—patients should report good to excellent knee function (score ≥37 on Oxford Knee Score or ≥71 on KOOS JR) by 1 year post-op. This patient-reported outcome reflects whether the surgery delivered its promise of improved mobility and quality of life. Weak results warrant review of patient selection, surgical technique, and rehabilitation protocols to improve outcomes.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 470 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

Orthopedic Surgery

Related Measures

Orthopedics

MIPS 350: Total Knee or Hip Replacement: Shared Decision-Making: Trial of Conservative (Non-MIPS 351: Total Knee or Hip Replacement: Venous Thromboembolic and Cardiovascular Risk MIPS 459: Back Pain After Lumbar Surgery MIPS 461: Leg Pain After Lumbar Surgery MIPS 471: Functional Status After Lumbar Surgery

Patient-Reported Outcomes

MIPS 191: Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery MIPS 217: Functional Status Change for Patients with Knee Impairments MIPS 218: Functional Status Change for Patients with Hip Impairments MIPS 219: Functional Status Change for Patients with Lower Leg, Foot or Ankle Impairments MIPS 220: Functional Status Change for Patients with Low Back Impairments MIPS 221: Functional Status Change for Patients with Shoulder Impairments MIPS 222: Functional Status Change for Patients with Elbow, Wrist or Hand Impairments MIPS 303: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract MIPS 420: Varicose Vein Treatment with Saphenous Ablation: Outcome Survey MIPS 459: Back Pain After Lumbar Surgery MIPS 461: Leg Pain After Lumbar Surgery MIPS 471: Functional Status After Lumbar Surgery MIPS 478: Functional Status Change for Patients with Neck Impairments MIPS 483: Person-Centered Primary Care Measure Patient Reported Outcome MIPS 485: Psoriasis – Improvement in Patient-Reported Itch Severity MIPS 486: Dermatitis – Improvement in Patient-Reported Itch Severity MIPS 505: Reduction in Suicidal Ideation or Behavior Symptoms

Official Resources

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

Clinical Rationale

Annually there are over 500,000 total knee replacement (TKR) procedures performed in the United States. It is projected that by 2030 the volume of this procedure will increase to over 3.48 million per year due to the aging baby- boomers, increased obesity and indications for TKR that extend to both younger as well as older patients (AAOS 2006 Kurtz).

From 2000 to 2006, the Medicare TKR rate overall in the United States increased 58%, from 5.5 to 8.7 per 1000 and TKR revisions currently represent 8.2% of all Medicare dollars spent. It is estimated that annual hospital charges for TKR will approach 40.8 billion dollars annually by 2015. For the Minnesota Medicare population in 2006, 9,856 patients underwent a primary hip or knee replacement procedure (DRG 544) and 1,174 patients had a hip or knee revision (DRG 545).

Nationally, for DRG 544 the average charge per hospitalization was $38,447 with an average payment of $11,916 (Value driven health care 2008 CMS). Target was derived from a study “Patient acceptable symptom states after total hip or knee replacement at mid-term follow-up” [Kuerentjes JC, Van Tol FR Bone Joint Res 2014; 3:7–13]. Receiver operating characteristic (ROC) curves identified a PASS threshold of 42 for the Oxford Hip Score (OHS) after Total Hip Replacement (THR) and 37 for the OKS after TKR.

THR patients with an OHS greater than or equal to 42 and TKR patients with an OKS greater than or equal to 37 had a higher NRS for satisfaction and a greater likelihood of being willing to undergo surgery again. The Patient Acceptable Symptom State (PASS), the highest level of symptom beyond which patients consider themselves well. PASS was compared to post-op OKS to determine an equivalent OKS threshold.

OKS score greater than or equal to 37 indicates the achievement of an acceptable symptom state and correlates with a higher numeric rating scale for satisfaction [ROC curves PASS threshold of 37 with sensitivity of 76.3% and specificity of 76.5%].

Clinical Recommendations

The American Association of Hip and Knee Surgeons (AAHKS) Total Knee Replacement Performance Measurement Set 2013 indicates a focus on collecting patient risk factors and implementing process measures with a future focus on outcome measures.

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. The most recent quality data code will be used if the measure is submitted more than once.

This measure is a target-based measure, where the numerator is met by having a one-year postoperative Oxford Knee Score (OKS) greater than or equal to 37 or a KOOS, JR. score greater than or equal to 71. It is expressed as a proportion or rate. Patients having received a primary total knee replacement procedure who are not assessed for functional status postoperatively remain in the denominator and are considered as not meeting the target.

The measure intent is that MIPS eligible clinicians will submit all denominator eligible procedures for performance calculation.

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