Who is eligible for MIPS 513?

DENOMINATOR (CRITERIA 1): Patients with an active diagnosis of a movement disorder, multiple sclerosis, a neuromuscular disorder, dementia, or stroke. Definition: Active – Active diagnosis means the diagnosis has to be coded or billed for on the date of service, not just a diagnosis on the historical problem list. DENOMINATOR (CRITERIA 2): Patients with an active diagnosis of a movement disorder, multiple sclerosis, a neuromuscular disorder, dementia, or stroke who report (or caregiver as appropriate) a fall occurred since last visit. Definition: Active – Active diagnosis means the diagnosis has to be coded or billed for on the date of service, not just a diagnosis on the historical problem list.

Is MIPS 513 the same as MIPS 513?

Yes. CMS uses zero-padded three-digit Quality IDs (513) in official specifications, while clinicians often search for MIPS 513 or Quality ID 513 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 513: Patient Reported Falls and Plan of Care?

Submission codes: M1492 (Patients who did not report a fall); M1495 (Patients that reported a fall occurred who had a plan of care for falls documented OR patients that did not report a fall); M1494 (Patients that reported a fall since the last visit); M1496 (Patients that had a fall who did not have a plan of care for falls documented OR do not have documentation of being assessed for falls)

How do I report MIPS Measure 513 in 2026?

MIPS Measure 513 (Quality ID 513) 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 513 a topped-out measure?

No, MIPS 513 is not topped out, meaning there is still meaningful performance variation across clinicians.

Measure ID: MIPS 513|Dementia|2026 Performance Year

2026 MIPS Measure #513: Patient Reported Falls and Plan of Care

Percentage of patients (or caregivers as appropriate) with an active diagnosis of a movement disorder, multiple sclerosis, a neuromuscular disorder, dementia, or stroke who reported a fall occurred and those that fell had a plan of care for falls documented at every visit.

ProcessDementiaGeriatricsNeurologyPatient Safety

Measure ID:MIPS 513 (Quality ID 513)

Collection:—

Topped Out:No

View CMS Spec ↗

Measure Specification

This measure produces 2 performance rates. Each rate has its own eligible population, numerator, and reporting codes.

Rate 1

Eligible Population

Eligible patients based on diagnosis codes

ANDPatient encounters during the performance period

Exclusions

None

Numerator

Patients (or caregivers as appropriate) that reported a fall occurred since the last visit.

Reporting Codes

Performance Met:

M1492Patients who did not report a fall

Performance Not Met:

M1494Patients that reported a fall since the last visit

○ Exceptions:

M1493Documentation of falls not performed due to medical reasons (e.g., syncope, Vertigo and related disorders, restless leg syndrome, Tourette syndrome/tic disorder, back pain, Concussion/mild traumatic brain injury (mTBI), cervical dystonia, or epilepsy)

Rate 2

Eligible Population

ANDPatients with an active diagnosis of a movement disorder, multiple sclerosis, a neuromuscular disorder, dementia, or stroke who report (or caregiver as appropriate) a fall occurred since last visit.

ANDPatient encounters during the performance period

Exclusions

None

Reporting Codes

Performance Met:

M1495Patients that reported a fall occurred who had a plan of care for falls documented OR patients that did not report a fall

Performance Not Met:

M1496Patients that had a fall who did not have a plan of care for falls documented OR do not have documentation of being assessed for falls

○ Exceptions:

M1497Documentation of falls not performed due to medical reasons (e.g., syncope, Vertigo and related disorders, restless leg syndrome, Tourette syndrome/tic disorder, back pain, Concussion/mild traumatic brain injury (mTBI), cervical dystonia, or epilepsy)

VBCA Insights

Why This Measure Matters

Patients with movement disorders, MS, neuromuscular conditions, dementia, or stroke are at high risk for falls. At every visit, ask whether they've fallen since the last appointment, and if yes, document a falls prevention plan (home modifications, physical therapy, assistive devices, medication review). Falls and fear of falling devastate quality of life; a documented plan shows the patient you take this risk seriously. Even young neurological patients can benefit from fall prevention—it's not just an elderly issue.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 513 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.

No benchmarks available for this measure.

Specialty Measure Sets

Neurology

Related Measures

Dementia

MIPS 282: Dementia: Functional Status Assessment MIPS 286: Dementia: Safety Concern Screening and Follow-Up for Patients with Dementia MIPS 288: Dementia: Education and Support of Caregivers for Patients with Dementia MIPS 291: Assessment of Cognitive Impairment or Dysfunction for Patients with Parkinson’s

Geriatrics

MIPS 048: Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in MIPS 050: Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years MIPS 155: Falls: Plan of Care MIPS 181: Elder Maltreatment Screen and Follow-Up Plan MIPS 238: Use of High-Risk Medications in Older Adults MIPS 282: Dementia: Functional Status Assessment MIPS 286: Dementia: Safety Concern Screening and Follow-Up for Patients with Dementia MIPS 288: Dementia: Education and Support of Caregivers for Patients with Dementia MIPS 500: Acute Posterior Vitreous Detachment Appropriate Examination and Follow-up MIPS 501: Acute Posterior Vitreous Detachment and Acute Vitreous Hemorrhage Appropriate

Neurology

MIPS 268: Epilepsy: Counseling for Women of Childbearing Potential with Epilepsy MIPS 291: Assessment of Cognitive Impairment or Dysfunction for Patients with Parkinson’s MIPS 293: Rehabilitative Therapy Referral for Patients with Parkinson’s Disease MIPS 478: Functional Status Change for Patients with Neck Impairments

Patient Safety

MIPS 130: Documentation of Current Medications in the Medical Record MIPS 145: Radiology: Exposure Dose Indices Reported for Procedures Using Fluoroscopy MIPS 155: Falls: Plan of Care MIPS 164: Coronary Artery Bypass Graft (CABG): Prolonged Intubation MIPS 168: Coronary Artery Bypass Graft (CABG): Surgical Re-Exploration MIPS 181: Elder Maltreatment Screen and Follow-Up Plan MIPS 259: Rate of Endovascular Aneurysm Repair (EVAR) of Small or Moderate Non-Ruptured MIPS 275: Inflammatory Bowel Disease (IBD): Assessment of Hepatitis B Virus (HBV) Status Before MIPS 286: Dementia: Safety Concern Screening and Follow-Up for Patients with Dementia MIPS 351: Total Knee or Hip Replacement: Venous Thromboembolic and Cardiovascular Risk MIPS 354: Anastomotic Leak Intervention MIPS 355: Unplanned Reoperation within the 30-Day Postoperative Period MIPS 357: Surgical Site Infection (SSI)MIPS 374: Closing the Referral Loop: Receipt of Specialist Report 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 392: Cardiac Tamponade and/or Pericardiocentesis Following Atrial Fibrillation MIPS 393: Infection within 180 Days of Cardiac Implantable Electronic Device (CIED) Implantation,MIPS 413: Door to Puncture Time for Endovascular Stroke Treatment MIPS 422: Performing Cystoscopy at the Time of Hysterectomy for Pelvic Organ Prolapse MIPS 432: Proportion of Patients Sustaining a Bladder or Bowel Injury at the time of any Pelvic

Official Resources

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

Clinical Rationale

Many studies have been conducted on the rate of falls for common neurological conditions. All of them indicate that falls are an issue for neurology patients with symptomology that affects movement and balance. Falls and the fear of falling can impact quality of life and should be addressed for populations most at risk for falling. In people age 65 years and older, falls are one of the leading causes of death.

However, patients with neurological conditions are often younger and are at an increased risk for falls due to disease symptomology. 127,456,106 non-fatal falls were recorded from 2001-2015. For those that were hospitalized due to the fall, the cost is approximately $39,000 per patient. The U.S. Preventive Services Task Force updated their recommendations for fall prevention in community-dwelling older adults.

There are many intervention recommendations for patients 65 years and older.

Clinical Recommendations

• The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls (B recommendation) • The USPSTF recommends that clinicians selectively offer multifactorial interventions to prevent falls to community-dwelling adults 65 years or older who are at increased risk for falls.

Existing evidence indicates that the overall net benefit of routinely offering multifactorial interventions to prevent falls is small.

Implementation Notes

This measure contains two strata defined by two submission criteria. This measure produces two performance rates. There are 2 Submission Criteria for this measure: 1) Patients with an active diagnosis of a movement disorder, multiple sclerosis, a neuromuscular disorder, dementia, or stroke. AND 2) Patients with an active diagnosis of a movement disorder, multiple sclerosis, a neuromuscular disorder, dementia, or stroke who report (or caregiver as appropriate) a fall occurred since last visit.

Submission Criteria 1 ensures the full patient population is being assessed and reporting requirements are met. This measure will be calculated with 2 performance rates: 1) Patients with a diagnosis of a movement disorder, multiple sclerosis, a neuromuscular disorder, dementia, or stroke who were assessed for at each visit during the performance period 2) Patients with a diagnosis of a movement disorder, multiple sclerosis, a neuromuscular disorder, dementia, or stroke who report a fall occurred since the last visit AND who have a plan of care for falls For accountability reporting in the CMS MIPS program, the rate for Submission Criteria 2 is used for performance.

For the purposes of data completeness, Submission Criteria 1 will be used. For the purposes of MIPS implementation, this visit measure is submitted each time a patient has a denominator eligible encounter during the performance period.

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