Who is eligible for MIPS 496?

Patients who have an office visit for prenatal or postpartum care, regardless of gestational age or prior prenatal care at other sites, for any age (including pregnant and postpartum minors), within outpatient obstetric (OB) visit at the hospital or in affiliated clinics; and labor and delivery (L&D). Definition: Not eligible for a cardiovascular disease (CVD) risk assessment with a standardized instrument – see Reference Coding

Is MIPS 496 the same as MIPS 496?

Yes. CMS uses zero-padded three-digit Quality IDs (496) in official specifications, while clinicians often search for MIPS 496 or Quality ID 496 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 496: Cardiovascular Disease (CVD) Risk Assessment Measure - Proportion of?

Submission codes: M1258 (CVD risk assessment performed, have a documented calculated risk score); M1257 (CVD risk assessment not performed or incomplete (e.g., CVD risk assessment was not documented), reason not otherwise specified)

How do I report MIPS Measure 496 in 2026?

MIPS Measure 496 (Quality ID 496) 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 496 a topped-out measure?

No, MIPS 496 is not topped out, meaning there is still meaningful performance variation across clinicians.

Measure ID: MIPS 496|Cardiovascular Health|2026 Performance Year

2026 MIPS Measure #496: Cardiovascular Disease (CVD) Risk Assessment Measure - Proportion of

Percentage of pregnant or postpartum patients who received a cardiovascular disease (CVD) risk assessment with a standardized instrument.

ProcessCardiovascular HealthMaternity CareObstetrics

Measure ID:MIPS 496 (Quality ID 496)

Collection:MIPS CQM

Topped Out:No

View CMS Spec ↗

Measure Specification

Eligible Population

All patients regardless of age

ANDDiagnosis for Pregnancy or Postpartum

ANDEncounter for pregnancy

ORPatient visits during the performance period

Exclusions

M1255Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an OB provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere)

M1256Prior history of known CVD: M1256

Numerator

Patients who are assessed for CVD risk via California Maternal Quality Care Collaborative (CMQCC) standardized algorithm. A completed CVD risk assessment will determine the patient to be at low risk or high risk of CVD. Patients will be assessed at their initial encounter with their healthcare provider for pregnancy-related care [prenatal visit, L&D, postpartum visit] and may need to repeat assessments if new symptoms develop.

Reporting Codes

Performance Met:

M1258CVD risk assessment performed, have a documented calculated risk score

Performance Not Met:

M1257CVD risk assessment not performed or incomplete (e.g., CVD risk assessment was not documented), reason not otherwise specified

VBCA Insights

Why This Measure Matters

Pregnant and postpartum patients face a major risk of heart attack, stroke, and other cardiovascular emergencies—more than one-third of pregnancy-related deaths are cardiovascular. This measure ensures you use a standardized tool (like the CMQCC algorithm) to assess cardiovascular risk during pregnancy or the postpartum period. Screen all pregnant patients early, identify high-risk features, and arrange appropriate follow-up and monitoring. Early recognition and management prevent emergencies and deaths.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 496 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

Estimate only — actual CMS scoring may vary based on reporting method, data completeness, and annual rule updates.

Your Performance Rate:%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.

Specialty Measure Sets

Certified Nurse Midwife Obstetrics/Gynecology

Related Measures

Cardiovascular Health

MIPS 236: Controlling High Blood Pressure MIPS 438: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

Maternity Care

MIPS 335: Maternity Care: Elective Delivery (Without Medical Indication) at < 39 Weeks (Overuse)MIPS 336: Maternity Care: Postpartum Follow-up and Care Coordination

Obstetrics

MIPS 268: Epilepsy: Counseling for Women of Childbearing Potential with Epilepsy MIPS 335: Maternity Care: Elective Delivery (Without Medical Indication) at < 39 Weeks (Overuse)MIPS 336: Maternity Care: Postpartum Follow-up and Care Coordination

Official Resources

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

Clinical Rationale

Cardiovascular disease (CVD) has emerged as the leading cause of maternal mortality in the United States, accounting for over one-third of all pregnancy-related deaths. Diagnosis of CVD is challenging as normal pregnancy may mimic CVD. Accurate diagnosis of CVD varies widely among pregnant and postpartum patients and may either result in a lack of follow- up patients who are at risk or may lead to unnecessary testing that burdens the resources of patients who are not at risk.

Patients who are identified at immediate or lifetime risk of developing CVD may be motivated to modify their behavior to improve their cardiovascular health. Our measure is used for standardized identification of pregnant and/or postpartum individuals with previously unknown CVD who are suspected to have or to be at risk of developing CVD. A CVD risk assessment distinguishes patients with a high probability of disease by analyzing several variables included in the tool.

For a universal use of cardiovascular risk assessment in pregnant and postpartum women, a reliable clinical screening approach that monitors the hospital and clinician performance is lacking. The implementation of a measure to perform universal CVD risk assessment in the obstetric population will lead to timely identification and follow-up of women at risk of CVD and reduce maternal morbidity and mortality.

This will help decrease the lifetime onset of CVD through risk factor modification strategies. The implementation of the measure at facilities and feedback on performance has raised awareness of the importance of CVD risk assessment among obstetricians. The easy use (takes less than one minute to complete CVD risk assessment) of the tool allows for integration into the clinic flow and provides an opportunity to discuss with patient actions to improve their cardiovascular during pregnancy and beyond.

We have not seen any evidence that the follow-up of patients who were deemed at high risk for CVD led to inappropriate use of resources.

Clinical Recommendations

Delays or missed diagnosis of CVD in pregnant and postpartum patients is the leading contributor to CVD related maternal mortality. Implementation and universal CVD risk assessment using a standardized tool would allow identification of patients at high risk of CVD that require additional cardiac testing and follow-up. We propose implementation of metrics on adherence to the standard risk assessment tool that allows clinicians to add value to the obstetric care of patients.

The measure is user friendly and can easily be calculated for the hospital system, the clinic group/facilities, or to monitor individual clinician performance. The measure allows for the identification of low-performing hospital systems, facilities, or clinicians and addresses modifiable gaps (Kuklina et al, 2011; Small et al, 2012).

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 for the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.

Report this measure through VBCA

Our QCDR handles measure selection, data validation, and submission—so you can focus on clinical performance.

Learn About Our QCDR →Talk to Us