2026 #509 MIPS Measure Melanoma: Tracking and Evaluation of Recurrence

‌2026 COLLECTION TYPE:

MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) CLINICAL QUALITY MEASURE (CQM)

‌MEASURE TYPE:

Process – High Priority

• INVERSE MEASURE (CRITERIA 2): LOWER SCORE – BETTER

‌DESCRIPTION:

‌Percentage of patients who had an excisional surgery for melanoma or melanoma in situ with initial American Joint Committee on Cancer (AJCC) staging of 0, I, or II, in the past 5 years in which the operating clinician examines and/or diagnoses the patient for recurrence of melanoma.

‌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 with a diagnosis of melanoma. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding. The intent of this measure is to ensure that patients who had an excisional surgery for melanoma or melanoma in situ in the past 5 years with an initial AJCC staging of 0, I, OR II have a follow up exam for melanoma recurrence. The exam for recurrence can be completed by any provider as long as it is documented in the medical record by the excising clinician that the exam was performed.

‌Measure Strata and Performance Rates:

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. All patients that the clinician has performed a type of excisional surgery for melanoma or melanoma in situ in the past 5 years with an initial AJCC staging of 0, I, or II.

AND

1. Documentation by the clinician who performed the surgery that an exam for recurrence of melanoma was performed on the patient within the performance period.

‌This measure will be calculated with 2 performance rates:

1. Documentation by the clinician who performed the surgery that an exam for recurrence of melanoma was performed on the patient within the performance period.
2. All patients that were diagnosed with a recurrent melanoma in the current performance period.

For accountability reporting in the CMS MIPS program, the rate for submission criteria 1 is used for performance.

‌Implementation Considerations:

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.

Performance rate 2 is an inverse measure which means a lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.

‌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.

‌ALL SUBMISSION CRITERIA: ALL PATIENTS WHO HAVE HAD EXCISIONAL SURGERY FOR MELANOMA OR MELANOMA IN SITU IN THE PAST 5 YEARS WITH AN INITIAL AJCC STAGING OF 0, I, OR II‌

‌DENOMINATOR (CRITERIA 1 & 2):

All patients that the clinician has performed a type of excisional surgery for melanoma or melanoma in situ in the past 5 years with an initial AJCC staging of 0, I, or II

‌Definitions:

Patients with an excisional surgery (denominator criteria M1386) – see Reference Coding

‌DENOMINATOR NOTE:

The past five year timeframe for an encounter begins at the start of the performance period.

*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 and older on the date of the encounter‌

AND

‌Diagnosis for Melanoma or Melanoma in situ on the date of the encounter (ICD-10-CM): C43.0, C43.10, C43.111, C43.112, C43.121, C43.122, C43.20, C43.21, C43.22, C43.30, C43.31, C43.39, C43.4, C43.51, C43.52, C43.59, C43.60, C43.61, C43.62, C43.70, C43.71, C43.72, C43.8, C43.9, D03.0, D03.10, D03.111, D03.112, D03.20, D03.121, D03.122, D03.30, D03.39, D03.4, D03.51, D03.52, D03.59, D03.60, D03.61, D03.62, D03.70, D03.71, D03.72, D03.8, D03.9‌

AND

‌Patients with an excisional surgery for melanoma or melanoma in situ in the past 5 years with an initial AJCC Staging of 0, I, or II at the start of the performance period: M1386

AND

Patient encounters during the performance period (CPT): 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*

WITHOUT

Encounters conducted via telehealth: M1426

AND NOT

DENOMINATOR EXCLUSION:

‌Patients who died during the performance period: M1387‌

‌Reference Coding:

Denominator Criteria for Excisional Surgery [M1386] is defined by the following coding only: 11600, 11601, 11602, 11603, 11604, 11606, 11620, 11621, 11622, 11623, 11624, 11626, 11640, 11641, 11642, 11643, 11644, 11646, 17311, 17312, 17313, 17314, 17315

‌NUMERATOR (CRITERIA 1):‌

‌Documentation by the clinician who performed the surgery that an exam for recurrence of melanoma was performed on the patient within the performance period.‌

‌Numerator Instructions:‌

Inverse Measure – Which means a lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.

Lost to Follow-up – For purposes of this measure, in addition to those patients that the clinician is unable to locate for follow-up after documentation of attempt, lost to follow-up includes documentation of patients who relocated outside of the geographic area, transferred to a new clinician, or who had changes in insurance and are unable to follow-up.

‌Numerator Options:‌

‌Performance Met: Patients with documentation of an exam performed for recurrence of melanoma (M1388)

OR

‌Denominator Exception: Documentation of patient reasons for no examination i.e., refusal of examination OR lost to follow-up (documentation must include information that the clinician was unable to reach the patient by phone, mail or secure electronic mail – at least one method must be documented) (M1392)‌‌

OR

‌Performance Not Met: Patients who do not have a documented exam performed for recurrence of melanoma or no documentation within the performance period (M1390)‌

NUMERATOR (CRITERIA 2):

‌All patients that were diagnosed with a recurrent melanoma in the current performance period.

‌Definitions:

Recurrent – For purposes of this measure, recurrence is local recurrence of where the anatomical location(s) of the excised lesion or Mohs surgery occurred for ALL qualifying excisions identified in the denominator. Other locations should not be counted for this measure.

Reported score – AJCC staging 0, I, or II

‌Numerator Instructions:

Lost to Follow-up – For purposes of this measure, in addition to those patients that the clinician is unable to locate for follow-up after documentation of attempt, lost to follow-up includes documentation of patients who relocated outside of the geographic area, transferred to a new clinician, or who had changes in insurance and are unable to follow-up.

‌Numerator Options: ‌

Performance Not Met: Patients who were not diagnosed with recurrent melanoma during the current performance period (M1393)

OR

‌Denominator Exception: Documentation of patient reasons for no examination, i.e., refusal of examination OR lost to follow-up (documentation must include information that the clinician was unable to reach the patient by phone, mail or secure electronic mail – at least one method must be documented) (M1392)

OR

‌Performance Met: All patients who were diagnosed with recurrent melanoma during the current performance period (M1391)

RATIONALE

Melanoma recurrence is an outcome that needs precise evaluation. This measure will allow for the development of a system in which melanomas can accurately be tracked so that we can truly understand the effectiveness of care. The literature describes a lack of a standard for follow-up, tracking, and evaluating melanoma in early-stage disease. This measure will evaluate the frequency of recurrence along with the type of recurrence (local, in transit, LN, systemic) that occurs after an excisional procedure.
It is also recognized that there may be a lack of communication between the excising clinician and the clinician who is following the patient longitudinally. This measure is also an initiative to drive a care-collaborative network that encourages communication about the recurrence status of melanoma patients.