2026 #385 MIPS Measure Adult Primary Rhegmatogenous Retinal Detachment Surgery: Visual Acuity Improvement Within 90 Days of Surgery

2026 COLLECTION TYPE:

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

‌MEASURE TYPE:

Outcome – High Priority

‌DESCRIPTION:

Patients aged 18 years and older who had surgery for primary rhegmatogenous retinal detachment and achieved an improvement in their visual acuity, from their preoperative level, within 90 days of surgery in the operative eye.

‌INSTRUCTIONS:

‌Reporting Frequency:

This measure is to be submitted each time 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 the patient receiving primary rhegmatogenous retinal detachment surgery.

‌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 procedure measure is submitted each time a procedure is performed.

This is an outcome measure and will be calculated solely using MIPS eligible clinician, group, or third-party intermediary submitted data.

• For patients who receive the surgical procedures specified in the denominator coding, it should be submitted whether or not the patient achieved an improvement of their visual acuity within 90 days of surgery.
• Include only procedures performed between January 1st and September 30th of the performance period. This will allow the post-operative period to occur before third-party intermediaries must submit data to CMS.

Telehealth:

NOT TELEHEALTH ELIGIBLE: This measure is not appropriate for nor applicable to the telehealth setting. This measure is procedure based and therefore doesn’t allow for the denominator criteria to be conducted via telehealth. It would be appropriate to remove these patients 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:

Patients aged 18 years and older who had surgery for primary rhegmatogenous retinal detachment.

‌Denominator Criteria (Eligible Cases):

Patients aged ≥ 18 years on the date of the procedure

AND

Patient procedure during the performance period (CPT): 67107, 67108, 67110

AND NOT

DENOMINATOR EXCLUSIONS:

Patients with a pre-operative visual acuity better than 20/40: M1453

OR

Surgical procedures that included the use of silicone oil: G9757

‌NUMERATOR:

Patients who achieved an improvement in their visual acuity, from their preoperative level, within 90 days of surgery in the operative eye.

‌Numerator Options:‌

Performance Met: Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery (G9516)

‌OR

Performance Not Met: Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given (G9517)

RATIONALE:

For management and treatment for PVD and RRD, the following apply (for goals of treatment):

•  Prevention of visual loss and functional impairment
•  Maintenance of quality of life

All patients with risk factors should be instructed to notify their ophthalmologist as soon as possible if they have a substantial change in symptoms, such as an increase in floaters, loss of visual field, or decrease in visual acuity develop. Studies demonstrate that the success rate increases with the recognition of risk factors and the practice of retina subspecialization. International studies report primary rhegmatogenous retinal surgery success rates ranging from 64 to 91%.