Measure ID: MIPS 499·Ophthalmology·2026 Performance Year

2026 MIPS Measure #499: Appropriate Screening and Plan of Care for Elevated Intraocular Pressure Following

Percentage of patients who had an intravitreal or periocular corticosteroid injection (e.g., triamcinolone, preservative-free triamcinolone, dexamethasone, dexamethasone intravitreal implant, or fluocinolone intravitreal implant) who, within seven (7) weeks following the date of injection, are screened for elevated intraocular pressure (IOP) with tonometry with documented IOP ≤ 25 mm Hg for injected eye OR if the IOP was > 25 mm Hg, a plan of care was documented.

ProcessOphthalmologyGlaucoma

Measure ID:MIPS 499 (Quality ID 499)

Collection:MIPS CQM

Topped Out:No

View CMS Spec ↗

Measure Specification

Eligible Population

All patients regardless of age

ANDPatient encounters during the performance period

WITHOUTEncounters conducted via telehealth: M1426

ANDPatients who had an intravitreal or periocular corticosteroid injection (e.g., triamcinolone, preservative-free triamcinolone, dexamethasone, dexamethasone intravitreal implant, or fluocinolone intravitreal implant): M1324

Exclusions

M1326Patients with a diagnosis of hypotony

Numerator

Number of patients who, within seven (7) weeks following the date of injection, are screened for elevated intraocular pressure (IOP) with tonometry with documented IOP ≤ 25 mm Hg for injected eye listed in chart OR if the IOP was > 25 mm Hg, a plan of care was documented.

Reporting Codes

Performance Met:

M1322Patients seen within 7 weeks following the date of injection AND are screened for elevated intraocular pressure (IOP) with tonometry with documented IOP ≤ 25 mm Hg for injected eye

M1323Patients seen within 7 weeks following the date of injection AND are screened for elevated intraocular pressure (IOP) with tonometry with documented IOP > 25 mm Hg AND a plan of care was documented

Performance Not Met:

M1321Patients who were not seen within 7 weeks following the date of injection for follow up OR who did not have a documented IOP OR no plan of care documented if the IOP was > 25 mm Hg

○ Exceptions:

M1325Patients who were not seen for reasons documented by clinician for patient or medical reasons (e.g., inadequate time for follow-up, patients who received a prior intravitreal or periocular steroid injection within the last six (6) months and had a subsequent IOP evaluation with IOP < 25mm Hg within seven (7) weeks of treatment)

VBCA Insights

Why This Measure Matters

After patients receive an intravitreal or periocular corticosteroid injection (common in ophthalmology), they're at risk for steroid-induced high eye pressure (elevated IOP) which can lead to glaucoma and vision loss. This measure ensures you screen for elevated IOP with tonometry within seven weeks after injection, and if IOP is high, you document a plan to manage it (drops, laser, or other interventions). Seven to nine weeks is the peak risk window, so timely screening and intervention prevent serious vision-threatening complications.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 499 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.

2026 MIPS 499 Benchmarks

Historical CMS benchmark deciles for MIPS quality measure 499 by collection type. Your performance rate falls into a decile, which determines your measure points (3–10).

MIPS CQMAvg. performance rate: 71.11%

Decile	Performance Rate Range	Points
Decile 1	4.39 - 42.85%	1 – 1.9
Decile 2	42.86 - 53.15%	2 – 2.9
Decile 3	53.16 - 63.88%	3 – 3.9
Decile 4	63.89 - 70.44%	4 – 4.9
Decile 5	70.45 - 76.26%	5 – 5.9
Decile 6	76.27 - 80.64%	6 – 6.9
Decile 7	80.65 - 84.84%	7 – 7.9
Decile 8	84.85 - 89.65%	8 – 8.9
Decile 9	89.66 - 94.93%	9 – 9.9
Decile 10	>= 94.94%	10

Specialty Measure Sets

Ophthalmology

Related Measures

Ophthalmology

MIPS 117: Diabetes: Eye Exam MIPS 141: Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 20% OR MIPS 191: Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery MIPS 303: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract MIPS 304: Cataracts: Patient Satisfaction within 90 Days Following Cataract Surgery MIPS 384: Adult Primary Rhegmatogenous Retinal Detachment Surgery: No Return to the Operating MIPS 385: Adult Primary Rhegmatogenous Retinal Detachment Surgery: Visual Acuity Improvement MIPS 389: Cataract Surgery: Difference Between Planned and Final Refraction MIPS 500: Acute Posterior Vitreous Detachment Appropriate Examination and Follow-up MIPS 501: Acute Posterior Vitreous Detachment and Acute Vitreous Hemorrhage Appropriate

Glaucoma

MIPS 141: Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 20% OR

Official Resources

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

Clinical Context

Clinical Rationale

Patients treated with corticosteroid therapy are at increased risk for elevated IOP leading to steroid-induced glaucoma and their quality of life may be negatively impacted due to visual impairments. Several randomized clinical trials and a systematic review identified that IOPs typically peak around 7-9 weeks. Ensuring that appropriate monitoring is conducted to detect and treat this complication is important to prevent significant visual morbidity.

This measure encourages providers to screen and treat patients identified with an elevated IOP in a timely manner.

Clinical Recommendations

While current clinical guidelines do not address the need to assess for elevated IOP following corticosteroid injection, a systematic review completed by Kiddee and colleagues (Kiddee, 2013) identified that 10.9% to 79.0% of these patients will develop clinically significant IOP elevations with the large variation in incidence dependent largely on the specific steroid utilized and dose administered.

The timing of IOP elevation also varies based on the type and dose; although, the available literature consistently shows IOP peaking in the 4-8 week range following injection with higher and earlier elevations following intravitreal triamcinolone injections as compared to intravitreal dexamethasone implants. This review recommended that IOP be assessed every two weeks in the first month and monthly for an additional six months at a minimum.

Well-designed randomized controlled trials also support initial follow-up of no later than seven weeks. The Standard of Care vs. Corticosteroid for Retinal Vein Occlusion (SCORE) study where pressures peaked within 52.5 days following 4 mg intravitreal triamcinolone acetonide injection and the GENEVA study examining the effectiveness of dexamethasone intravitreal injections saw IOP peak within 60 days (Haller, 2010; Aref, 2015).

For patients with a diagnosis of glaucoma, these symptoms can occur earlier and we would expect the follow up timeframe would occur sooner such as within the first four weeks following the injection (Vie, 2017).

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

Frequently Asked Questions

Who is eligible for MIPS 499?

Patients who had an intravitreal or periocular corticosteroid injection (e.g., triamcinolone, preservative-free triamcinolone, dexamethasone, dexamethasone intravitreal implant, or fluocinolone intravitreal implant) with a patient encounter during the performance period.

Is MIPS 499 the same as MIPS 499?

Yes. CMS uses zero-padded three-digit Quality IDs (499) in official specifications, while clinicians often search for MIPS 499 or Quality ID 499 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 499: Appropriate Screening and Plan of Care for Elevated Intraocular Pressure Following?

Submission codes: M1322 (Patients seen within 7 weeks following the date of injection AND are screened for elevated intraocular pressure (IOP) with tonometry with documented IOP ≤ 25 mm Hg for injected eye); M1323 (Patients seen within 7 weeks following the date of injection AND are screened for elevated intraocular pressure (IOP) with tonometry with documented IOP > 25 mm Hg AND a plan of care was documented); M1321 (Patients who were not seen within 7 weeks following the date of injection for follow up OR who did not have a documented IOP OR no plan of care documented if the IOP was > 25 mm Hg)

How do I report MIPS Measure 499 in 2026?

MIPS Measure 499 (Quality ID 499) 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 499 a topped-out measure?

No, MIPS 499 is not topped out, meaning there is still meaningful performance variation across clinicians.

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