Who is eligible for MIPS 490?

Patients 18 years and older, with a diagnosis of cancer and on immune checkpoint inhibitors and who have grade 2 or above diarrhea and/or grade 2 or above colitis. Definitions: Episode – Onset of grade 2 or above diarrhea or grade 2 colitis or above until resolution. Immune checkpoint inhibitors – Class of medications that prevent tumors from “hiding” or “evading” the body’s natural immune system. This is a form of cancer immunotherapy. Immune checkpoint inhibitor medications include PD-1 inhibitor drugs, PD-L1 inhibitor drugs, CTLA-4 inhibitor drugs, and LAG-3 inhibitor drug. • PD-1 inhibitors drugs include: Pembrolizumab, Nivolumab, Cemiplimab • PD-L1 inhibitors drugs include: Atezolizumab, Avelumab, Durvalumab • CTLA-4 inhibitor drugs include: Ipilimumab, Tremelimumab • LAG-3 inhibitor drug include: Relatlimab Grade 2 Diarrhea – 4-6 bowel movements above baseline per day. Moderate increase in ostomy output compared to baseline; limiting instrumental ADL. Grade 3 Diarrhea – Increase of ≥ 7 stools per day over baseline; hospitalization indicated; severe increase in ostomy output compared to baseline; limiting self-care ADL. Grade 4 Diarrhea – Life-threatening consequences; urgent intervention indicated. Grade 2 Colitis – Abdominal pain, mucus or blood in stool. Grade 3 Colitis – Severe abdominal pain; peritoneal signs. Grade 4 Colitis – Life-threatening consequences; urgent intervention indicated.

Is MIPS 490 the same as MIPS 490?

Yes. CMS uses zero-padded three-digit Quality IDs (490) in official specifications, while clinicians often search for MIPS 490 or Quality ID 490 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 490 in 2026?

MIPS Measure 490 (Quality ID 490) 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 490 a topped-out measure?

No, MIPS 490 is not topped out, meaning there is still meaningful performance variation across clinicians.

Measure ID: MIPS 490|Oncology|2026 Performance Year

2026 MIPS Measure #490: Appropriate Intervention of Immune-Related Diarrhea and/or Colitis in Patients Treated

Percentage of patients aged 18 years and older, with a diagnosis of cancer, on immune checkpoint inhibitor therapy, and grade 2 or above diarrhea and/or grade 2 or above colitis, who have immune checkpoint inhibitor therapy held and corticosteroids or immunosuppressants prescribed or administered.

ProcessOncologyMedication Management

Measure ID:MIPS 490 (Quality ID 490)

Collection:MIPS CQM

Topped Out:No

View CMS Spec ↗

Measure Specification

Eligible Population

Patients aged ≥ 18 years on the date of the encounter

ANDDiagnosis of Cancer on the date of the encounter

ANDPatient encounter during the performance period

ANDPatients on immune checkpoint inhibitor therapy: M1180

ANDGrade 2 or above diarrhea and/or grade 2 or above colitis: M1181

Exclusions

M1182Patients not eligible due to pre-existing inflammatory bowel disease (IBD) (e.g., ulcerative colitis, Crohn’s disease)

Numerator

Patients with immune checkpoint inhibitor therapy held and corticosteroids or immunosuppressants prescribed or administered

Reporting Codes

Performance Met:

M1183Documentation of immune checkpoint inhibitor therapy held and corticosteroids or immunosuppressants prescribed or administered

Performance Not Met:

M1185Documentation of immune checkpoint inhibitor therapy not held and/or corticosteroids or immunosuppressants prescribed or administered was not performed, reason not given

○ Exceptions:

M1184Documentation of medical reason(s) for not prescribing or administering corticosteroid or immunosuppressant treatment (e.g., allergy, intolerance, infectious etiology, pancreatic insufficiency, hyperthyroidism, prior bowel surgical interventions, celiac disease, receiving other medication, awaiting diagnostic workup results for alternative etiologies, other medical reasons/contraindication)

VBCA Insights

Why This Measure Matters

When cancer patients on immunotherapy develop moderate to severe diarrhea or colitis, you must act quickly by holding the immune checkpoint inhibitor and starting corticosteroids or other immunosuppressants—these symptoms can become life-threatening if ignored. This is a safety measure that prevents immune-related toxicity from becoming a crisis. Have a clear protocol for recognizing and grading GI toxicity, educate patients on what to report, and be ready to intervene within 24 hours. Close communication with your oncology team ensures smooth coordination.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 490 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

Oncology/Hematology

Related Measures

Oncology

MIPS 102: Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate MIPS 143: Oncology: Medical and Radiation – Pain Intensity Quantified MIPS 144: Oncology: Medical and Radiation – Plan of Care for Pain MIPS 249: Barrett’s Esophagus MIPS 250: Radical Prostatectomy Pathology Reporting MIPS 395: Lung Cancer Reporting (Biopsy/Cytology Specimens)MIPS 396: Lung Cancer Reporting (Resection Specimens)MIPS 397: Melanoma Reporting MIPS 401: Hepatitis C: Screening for Hepatocellular Carcinoma (HCC) in Patients with Cirrhosis MIPS 450: Appropriate Treatment for Patients with Stage I (T1c) – III HER2 Positive MIPS 453: Percentage of Patients who Died from Cancer Receiving Systemic Cancer-Directed MIPS 457: Percentage of Patients who Died from Cancer Admitted to Hospice for Less than 3 MIPS 491: Mismatch Repair (MMR) or Microsatellite Instability (MSI) Biomarker Testing MIPS 506: Positive PD-L1 Biomarker Expression Test Result Prior to First-Line Immune Checkpoint MIPS 507: Appropriate Germline Testing for Ovarian Cancer Patients MIPS 509: Melanoma: Tracking and Evaluation of Recurrence

Medication Management

MIPS 005: Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or MIPS 007: Coronary Artery Disease (CAD): Beta-Blocker Therapy – Prior Myocardial MIPS 008: Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic MIPS 118: Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE)MIPS 130: Documentation of Current Medications in the Medical Record MIPS 180: Rheumatoid Arthritis (RA): Glucocorticoid Management MIPS 268: Epilepsy: Counseling for Women of Childbearing Potential with Epilepsy MIPS 410: Psoriasis: Clinical Response to Systemic Medications MIPS 468: Continuity of Pharmacotherapy for Opioid Use Disorder (OUD)MIPS 489: Adult Kidney Disease: Angiotensin Converting Enzyme (ACE) Inhibitor or

Official Resources

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

Clinical Rationale

This measure is designed to promote appropriate intervention of managing immune-related diarrhea and colitis, as recommended by numerous clinical guidelines on the topic of toxicities in immunotherapy. The occurrence of diarrhea and colitis can be a normal and treatable toxicity (and is many times not immune-related), but if it is immune-related, it can become life-threatening if not addressed in a timely manner.

Diarrhea and colitis are the second- most commonly reported AEs (adverse events) with ICIs (immune checkpoint inhibitors), and symptoms typically develop within 6 to 8 weeks of starting treatment. Preventing diarrhea includes early recognition of symptoms. Proper grading of diarrhea is essential for proper management. Regardless of immunotherapy agent used, effective colitis and diarrhea management is accomplished by early intervention.

Colitis related mortality with immunotherapy agents has been associated with delayed reporting, nonadherence with antidiarrheal regimen, and failure to hold the immunotherapy agent. With early intervention, colitis is reversible. Incidence of diarrhea is higher among patients taking combination anti-CTLA-4/anti-PD-1 therapy (44%) than those receiving anti-CTLA4 (23–33 percent) or anti-PD-1 (≤19 percent) monotherapy.

The combinatorial approach is also associated with increased risk of grade 3-4 symptoms compared with monotherapy, and the proportion of patients experiencing high-grade symptoms is greater with ipilimumab than anti-PD-1 or antiPD-L1 agents. Diarrhea and/or colitis may recur months after discontinuation of immunotherapy and can mimic chronic inflammatory bowel disease (IBD).

The hallmark symptom of ipilimumab-associated colitis is 3-20 loose bowel movements per day with possible associated hematochezia. For patients on pembrolizumab, 16 percent of patients have diarrhea of any grade, while 1 percent of patients will have grade 3-4 diarrhea.. This quality measure will support and possibly incentivize efforts to implement these necessary improvements to practice quality in the field of immunotherapy.

This quality measure includes all FDA approved Immune Checkpoint Inhibitors and is updated annually to reflect the most up-to-date list of approved therapies.

Clinical Recommendations

All the five clinical guidelines below address the measure’s quality actions of holding immunotherapy and administering corticosteroids or immunosuppressant for grade 2 or above diarrhea and/or grade 2 or above colitis. The measure will enhance compliance with the clinical guidelines by ensuring the eligible provider is addressing the adverse event of diarrhea or colitis by immediately providing an intervention to prevent the adverse event from worsening.

Implementation Notes

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. Telehealth: TELEHEALTH ELIGIBLE: This measure is appropriate for and applicable to the telehealth setting. Patient encounters conducted via telehealth using encounter code(s) found in the denominator encounter criteria are allowed for this measure.

Therefore, if the patient meets all denominator criteria for a telehealth encounter, it would be appropriate to include them in the denominator eligible patient population. Telehealth eligibility is at the measure level for inclusion within the denominator eligible patient population and based on the measure specification definitions which are independent of changes to coding and/or billing practices.

Measure Submission: The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this collection type for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. The coding provided to identify the measure criteria: Denominator or Numerator, may be an example of coding that could be used to identify patients that meet the intent of this clinical topic.

When implementing this measure, please refer to the ‘Reference Coding’ section to determine if other codes or code languages that meet the intent of the criteria may also be used within the medical record to identify and/or assess patients. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

For the purposes of MIPS implementation, this episode measure is submitted once for each occurrence of immune-related diarrhea and/or colitis during the performance period.

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