2026 COLLECTION TYPE:
MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) CLINICAL QUALITY MEASURE (CQM)
Description:
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or within the previous twelve months AND who had a follow-up plan documented if the most recent BMI was outside of normal parameters.
Instructions:
Reporting Frequency:
This measure is to be submitted a minimum of once per performance period for denominator eligible cases as defined in the denominator criteria.
Intent and Clinician Applicability:
This measure is intended to reflect the quality of services provided for patients seen during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions as defined by the numerator based on the services provided and the measure-specific denominator coding.
Measure Strata and Performance Rates:
This measure contains one strata defined by a single submission criteria.
This measure produces a single performance rate.
Implementation Considerations:
For the purposes of MIPS implementation, this patient-intermediate measure is submitted a minimum of once per patient for the performance period. The most recent numerator option/quality data code will be used if the measure is submitted more than once.
There is no diagnosis associated with this measure. The BMI may be documented in the medical record of the provider or in outside medical records obtained by the provider. If the most recent documented BMI is outside of normal parameters, then a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter. The documented follow-up plan must be based on the most recent documented BMI outside of normal parameters, example: “Patient referred to nutrition counseling for BMI above or below normal parameters” (See Definitions for examples of follow-up plan treatments). If more than one BMI is submitted during the measurement period, the most recent BMI will be used to determine if the performance has been met. Review the exclusions and exceptions criteria to determine those patients that BMI measurement may not be appropriate or necessary.
This measure specification is only available for MIPS Value Pathway (MVP) reporting and is not available for traditional MIPS reporting.
Telehealth:
NOT TELEHEALTH ELIGIBLE: This measure is not appropriate for nor applicable to the telehealth setting. Patient encounters for this measure conducted via telehealth should be removed from the denominator eligible patient population. Therefore, if the patient meets all denominator criteria but the encounter is conducted via telehealth, it would be appropriate to remove them from 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.
Denominator:
All patients aged 18 and older on the date of the encounter with at least one qualifying encounter during the measurement period.
Definition:
Not Eligible for BMI Screening or Follow-Up Plan (Denominator Exclusions) – A patient is not eligible if one or more of the following reasons are documented:
• Patients receiving palliative or hospice care on the date of the current encounter or any time prior to the current encounter
• Patients who are pregnant on the date of the current encounter or any time during the measurement period prior to the current encounter
Denominator Note:
*Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.
Denominator Criteria (eligible Cases):
Patients aged ≥ 18 years on date of encounter
And
Patient encounter during performance period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 96156, 96158, 97161, 97162, 97163, 97165, 97166, 97167, 97802, 97803, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, 99424, 99491, D7111, D7140, D7210, D7220, D7230, D7240, D7241, D7250, D7251, G0101, G0108, G0270, G0271, G0402, G0438, G0439, G0447, G0473
Without
Encounters conducted via telehealth: M1431
Without
Place of Service (POS): 12
And Not
Denominator Exclusions:
Documentation stating the patient has received or is currently receiving palliative or hospice care: G9996
Or
Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter: G9997
Numerator:
Patients with a documented BMI during the encounter or during the previous twelve months AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the encounter.
Definitions:
Normal BMI Parameters – Age 18 years and older BMI ≥ 18.5 and < 25 kg/m2 BMI – Body mass index (BMI) is a number calculated using the Quetelet index: weight divided by height squared
(W/H2) and is commonly used to classify weight categories. “BMI” can be calculated using:
Metric Units: BMI = Weight (kg) / (Height (m) x Height (m))
Or
English Units: BMI = Weight (lbs) / (Height (in) x Height (in)) x 703
Follow-Up Plan – Proposed outline of treatment to be conducted as a result of a BMI outside of normal parameters. A “follow-up” plan may include, but is not limited to:
• Documentation of education
• Referral (for example a Registered Dietitian Nutritionist (RDN), occupational therapist, physical therapist, primary care provider, exercise physiologist, mental health professional, or surgeon) for lifestyle/behavioral therapy
• Pharmacological interventions
• Dietary supplements
• Exercise counseling
• Nutrition counseling
Patients with a Documented Reason for Not Screening BMI (Denominator Exception) – Patient Reason:
• Patients who refuse measurement of height and/or weight on the date of the current encounter or any
time during the measurement period prior to the current encounter
Or
Medical Reason:
• Patients with a documented medical reason for not documenting BMI such as patients in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient’s health status.
Patients with a Documented Reason for Not Documenting a Follow-up Plan for BMI Outside Normal Parameters (Denominator Exception) – Medical Reason(s):
• Patients (e.g., elderly patients 65 years of age or older) for whom weight reduction/weight gain would complicate other underlying health conditions such as illness or physical disability, mental illness, dementia, confusion, or nutritional deficiency such as vitamin/mineral deficiency; patients in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient’s health status
Numerator Instructions:
Height and Weight – An eligible clinician or their staff is required to measure both height and weight. Both height and weight must be measured within twelve months of the current encounter. Self-reported values cannot be used.
• The BMI may be documented in the medical record of the provider or in outside medical records obtained by the provider.
• If more than one BMI is reported during the measurement period, the most recent BMI will be used to determine if the performance has been met.
Follow-Up Plan – If the most recent documented BMI is outside of normal parameters, then a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter. The documented follow-up plan must be based on the most recent documented BMI, outside of normal parameters, example: “Patient referred to nutrition counseling for BMI above or below normal parameters”. (See Definitions for examples of follow-up plan treatments).
Performance Met for G8417 & G8418 –
• If the provider documents a BMI and a follow-up plan for a BMI outside normal parameters at the current encounter Or
• If the patient has a documented BMI within the previous twelve months of the current encounter, the provider documents a follow-up plan for a BMI outside normal parameters at the current encounter
Or
• If the patient has a documented BMI within the previous twelve months of the current encounter And the patient has a documented follow-up plan for a BMI outside normal parameters within the previous twelve months of the current encounter
Numerator Note: If multiple glycemic status assessments were recorded for a single date, use the lowest result.
Numerator Options:
Performance Met: BMI is documented within normal parameters and no follow-up plan is required (G8420)
Or
Performance Met: BMI is documented above normal parameters and a followup plan is documented (G8417)
Or
Performance Met: BMI is documented below normal parameters and a followup plan is documented (G8418)
Or
Denominator Exception: BMI not documented due to medical reason OR patient refusal of height or weight measurement (G2181)
Or
Denominator Exception: BMI is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason (G9716)
Or
Performance Not Met: BMI not documented and no reason is given (G8421)
Or
Performance Not Met: BMI documented outside normal parameters,
Rationale:
BMI Above Normal Parameters
“Obesity is a chronic, multifactorial disease with complex psychological, environmental (social and cultural), genetic, physiologic, metabolic and behavioral causes and consequences. The prevalence of overweight and obese people is increasing worldwide at an alarming rate in both developing and developed countries. Environmental and behavioral changes brought about by economic development, modernization and urbanization have been linked to the rise in global obesity. The health consequences are becoming apparent (1).”
More than a third of U.S. adults have a body mass index (BMI) ≥ 30 kg/m2 and are at increased risk for diabetes, cardiovascular disease (CVD), and obstructive sleep apnea (2,3, 4). Hales reported that the prevalence of obesity among adults and youth in the United States was 39.8 percent and 18.5 percent respectively, from 2015–2016. Furthermore, the prevalence of obesity in adults increased to 42.4 percent in 2018, with the highest percentage among adults in the 40–59 age bracket compared with other age groups (5). Hales also disaggregated the data according to race/ethnicity and noted that obesity prevalence was higher among non-Hispanic Black adults and Hispanic adults when compared with other races and ethnicities. Obesity prevalence was lowest among nonHispanic Asian men and women. Among men, obesity prevalence was higher among Hispanic men compared with non-Hispanic Black men and non-Hispanic White men. Obesity prevalence was higher among Hispanic men compared with non-Hispanic Black men. Among women, the prevalence among non-Hispanic Black women was 56.9 percent, which was higher than all other race/ethnicities. In general, the prevalence of obesity in the U.S. remains higher than the Healthy People 2020 goal of 30.5 percent among adults (6).
BMI continues to be a common and reasonably reliable measurement to identify overweight and obese adults who may be at an increased risk for future morbidity. Although good quality evidence supports obtaining a BMI, it is important to recognize it is not a perfect measurement. For example, BMI and its associated disease and mortality risk appear to vary among ethnic subgroups. Black/African Americans appear to have the lowest mortality risk at a BMI of 26.2-28.5 kg/m2 in Black women and 27.1-30.2 kg/m2 in Black men. In contrast, Asian populations may experience lowest mortality rates starting at a BMI of 23 to 24 kg/m2. The correlation between BMI and diabetes risk also varies by ethnicity (7). Moreover, BMI is not a direct measure of adiposity and as a consequence, it can over or underestimate adiposity. However, overall, BMI is a derived value that correlates well with total body fat and markers of secondary complications, e.g., hypertension and dyslipidemia (8).
Furthermore, it is important to enhance beneficiary access to appropriate treatments for obesity, which could result in decreased healthcare costs and lower obesity rates. Behavioral weight management treatment has been identified as an effective first-line treatment for obesity with an average initial weight loss of 8-10 percent. This percentage of weight loss is associated with a significant risk reduction for diabetes and CVD (9). Evidence also shows that when provided 14 or more high-intensity behavioral intervention sessions of face-to-face individual or group treatment across 6 months, participants lose up to 8 percent of their weight during that time and experience improvements in heart disease risk factors and quality of life (10). There is also evidence that high-intensity behavioral counseling is effective, whether delivered in-person, by phone, or electronically (11). Moreover, Intensive Behavioral Therapy (IBT) for obesity provided by Registered Dietitian Nutritionists for 6-12 months shows significant mean weight loss of up to 10 percent of body weight, maintained over one year’s time (12).
Despite the evidence that supports weight management counseling, the rate of use in primary care for patients with obesity decreased by 10 percent from 39.9 percent in 1995-1996 to 29.9 percent in 2007-2008 (13). Weight management counseling during primary care visits further declined from 33 percent to 21 percent between 2008- 2009 and 2012-2013. This suggests that obesity management in primary care remains suboptimal (14). Therefore, screening for BMI and follow-up is critical and will help in reaching the quality goals of population health and cost reduction. However, due to concerns for other underlying conditions (such as bone health) or nutrition related deficiencies providers are cautioned to use their best clinical judgment and when considering weight management programs for overweight patients, especially the elderly (15).
BMI Below Normal Parameters
On the other end of the body weight spectrum is underweight (BMI < 18.5 kg/m2), which is also detrimental to population health. When compared to normal weight individuals (BMI 18.5-25 kg/m2), underweight individuals have significantly higher death rates with a Hazard Ratio of 2.27 and 95 percent confidence intervals (CI) = 1.78, 2.90 (16). Individuals with a BMI < 18.5kg/m2 have been shown to be at a higher risk for adverse events, postoperative infection, and/or mortality following a surgical procedure (17, 18, 19, 20). BMI below normal parameters is a risk factor for developing severe illness from respiratory infections such as influenza and COVID19 (21, 22). BMI below normal parameters can negatively impact both male and female fertility (23, 24)
Poor nutrition or underlying health conditions can result in underweight (25). The National Health and Nutrition Examination Survey (NHANES) results from 2007-2010 indicate that women are more likely to be underweight than men (25). However, all patients should be equally screened for underweight and followed up with nutritional counseling or another clinically appropriate intervention to reduce mortality and morbidity associated with underweight.
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