The 2023 MIPS reporting deadline is April 1, 2024. 

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Quality performance category
2020 MIPS

  • Select 6 measures
  • 1 outcome or high-priority measure
  • Alternatively, a specialty or sub-specialty measure set may be used
  • Report 70% of applicable visits from a full calendar year
  • Population measure automatically calculated, if applicable
45 %
MIPS Final Score

Key changes from 2019

Click each option to learn more!

Data completeness threshold increased from 60% to 70% of clinician's or group' patient across all payers for the performance period

Modified Benchmarks to Avoid Potential Patient Risk

Removed 42 measures, revised 83, and added 4 new Quality measures

Topped Out Measures in 2020 - these measures will receive a maximum score of 7 points

Measure TitleMeasure IDCollection
Type
Documentation of Current Medications in the Medical Record130eCQM
Oncology: Medical and Radiation - Pain Intensity Quantified143eCQM
Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation12Medicare Part B Claims
Age-Related Macular Degeneration (AMD): Dilated Macular Examination14Medicare Part B Claims
Perioperative Care: Selection of Prophylactic Antibiotic - First OR Second-Generation Cephalosporin21Medicare Part B Claims
Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients)23Medicare Part B Claims
Communication with the Physician or Other Clinician Managing On-Going Care Post-Fracture for Men and Women Aged 50 Years and Older24Medicare Part B Claims
Advance Care Plan47Medicare Part B Claims
Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older48Medicare Part B Claims
Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older50Medicare Part B Claims
Chronic Obstructive Pulmonary Disease (COPD): Long-Acting Inhaled Bronchodilator Therapy52Medicare Part B Claims
Prevention of Central Venous Catheter (CVC) - Related Bloodstream Infections76Medicare Part B Claims
Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy - Avoidance of Inappropriate Use93Medicare Part B Claims
Diabetes: Eye Exam117Medicare Part B Claims
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan128Medicare Part B Claims
Documentation of Current Medications in the Medical Record130Medicare Part B Claims
Preventive Care and Screening: Screening for Depression and Follow-Up Plan134Medicare Part B Claims
Radiology: Exposure Dose Indices or Exposure Time and Number of Images Reported for Procedures Using Fluoroscopy145Medicare Part B Claims
Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy147Medicare Part B Claims
Falls: Risk Assessment154Medicare Part B Claims
Falls: Plan of Care155Medicare Part B Claims
Elder Maltreatment Screen and Follow-Up Plan181Medicare Part B Claims
Functional Outcome Assessment182Medicare Part B Claims
Radiology: Stenosis Measurement in Carotid Imaging Reports195Medicare Part B Claims
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention226Medicare Part B Claims
Barrett's Esophagus249Medicare Part B Claims
Radical Prostatectomy Pathology Reporting250Medicare Part B Claims
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented317Medicare Part B Claims
Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients320Medicare Part B Claims
Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy326Medicare Part B Claims
Lung Cancer Reporting (Biopsy/Cytology Specimens)395Medicare Part B Claims
Melanoma Reporting397Medicare Part B Claims
Photodocumentation of Cecal Intubation425Medicare Part B Claims
Radiation Consideration for Adult CT: Utilization of Dose Lowering Techniques436Medicare Part B Claims
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)8MIPS CQM
Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation12MIPS CQM
Age-Related Macular Degeneration (AMD): Dilated Macular Examination14MIPS CQM
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care19MIPS CQM
Perioperative Care: Selection of Prophylactic Antibiotic - First OR Second-Generation Cephalosporin21MIPS CQM
Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients)23MIPS CQM
Coronary Artery Bypass Graft (CABG): Preoperative Beta-Blocker in Patients with Isolated CABG Surgery44MIPS CQM
Chronic Obstructive Pulmonary Disease (COPD): Long-Acting Inhaled Bronchodilator Therapy52MIPS CQM
Appropriate Treatment for Children with Upper Respiratory Infection (URI)65MIPS CQM
Prevention of Central Venous Catheter (CVC) - Related Bloodstream Infections76MIPS CQM
Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy - Avoidance of Inappropriate Use93MIPS CQM
Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients102MIPS CQM
Prostate Cancer: Combination Androgen Deprivation Therapy for High Risk or Very High Risk Prostate Cancer104MIPS CQM
Diabetes: Eye Exam117MIPS CQM
Documentation of Current Medications in the Medical Record130MIPS CQM
Melanoma: Coordination of Care138MIPS CQM
Oncology: Medical and Radiation - Pain Intensity Quantified143MIPS CQM
Radiology: Exposure Dose Indices or Exposure Time and Number of Images Reported for Procedures Using Fluoroscopy145MIPS CQM
Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy147MIPS CQM
Falls: Risk Assessment154MIPS CQM
Rheumatoid Arthritis (RA): Functional Status Assessment178MIPS CQM
Colonoscopy Interval for Patients with a History of Adenomatous Polyps - Avoidance of Inappropriate Use185MIPS CQM
Stroke and Stroke Rehabilitation: Thrombolytic Therapy187MIPS CQM
Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery191MIPS CQM
Radiology: Stenosis Measurement in Carotid Imaging Reports195MIPS CQM
Barrett's Esophagus249MIPS CQM
Radical Prostatectomy Pathology Reporting250MIPS CQM
Ultrasound Determination of Pregnancy Location for Pregnant Patients with Abdominal Pain254MIPS CQM
Sentinel Lymph Node Biopsy for Invasive Breast Cancer264MIPS CQM
Biopsy Follow-Up265MIPS CQM
Sleep Apnea: Assessment of Adherence to Positive Airway Pressure Therapy279MIPS CQM
Dementia: Functional Status Assessment282MIPS CQM
Dementia Associated Behavioral and Psychiatric Symptoms Screening and Management283MIPS CQM
Dementia: Safety Concern Screening and Follow-Up for Patients with Dementia286MIPS CQM
Parkinson's Disease: Cognitive Impairment or Dysfunction Assessment for Patients with Parkinson's Disease291MIPS CQM
Parkinson's Disease: Rehabilitative Therapy Options293MIPS CQM
Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients320MIPS CQM
Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy326MIPS CQM
Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin With or Without Clavulanate Prescribed for Patients with Acute Bacterial Sinusitis (Appropriate Use)332MIPS CQM
Total Knee Replacement: Shared Decision-Making: Trial of Conservative (Non-surgical) Therapy350MIPS CQM
Total Knee Replacement: Venous Thromboembolic and Cardiovascular Risk Evaluation351MIPS CQM
Patient-Centered Surgical Risk Assessment and Communication358MIPS CQM
Optimizing Patient Exposure to Ionizing Radiation: Count of Potential High Dose Radiation Imaging Studies: Computed Tomography (CT) and Cardiac Nuclear Medicine Studies360MIPS CQM
Closing the Referral Loop: Receipt of Specialist Report374MIPS CQM
Adult Primary Rhegmatogenous Retinal Detachment Surgery: No Return to the Operating Room Within 90 Days of Surgery384MIPS CQM
Hepatitis C: Discussion and Shared Decision Making Surrounding Treatment Options390MIPS CQM
Lung Cancer Reporting (Biopsy/Cytology Specimens)395MIPS CQM
Lung Cancer Reporting (Resection Specimens)396MIPS CQM
Melanoma Reporting397MIPS CQM
Tobacco Use and Help with Quitting Among Adolescents402MIPS CQM
Opioid Therapy Follow-up Evaluation408MIPS CQM
Documentation of Signed Opioid Treatment Agreement412MIPS CQM
Evaluation or Interview for Risk of Opioid Misuse414MIPS CQM
Perioperative Temperature Management424MIPS CQM
Photodocumentation of Cecal Intubation425MIPS CQM
Prevention of Post-Operative Nausea and Vomiting (PONV) - Combination Therapy430MIPS CQM
Radiation Consideration for Adult CT: Utilization of Dose Lowering Techniques436MIPS CQM
Skin Cancer: Biopsy Reporting Time - Pathologist to Clinician440MIPS CQM
Medication Management for People with Asthma444MIPS CQM
Prevention of Post-Operative Vomiting (POV) - Combination Therapy (Pediatrics)463MIPS CQM
Otitis Media with Effusion: Systemic Antimicrobials - Avoidance of Inappropriate Use464MIPS CQM
Otitis Media with Effusion: Systemic Antimicrobials - Avoidance of Inappropriate Use464MIPS CQM

Quality Performance Category Submission Options

An organization may choose to submit measure data to CMS as an individual or as a group through any of the options below.

Collection Type

Individual Submisson

Group Submission

Clinical Quality Measures ( Formerly Qualified Registries)

QCDR Measures

Electronic Clinical Quality Measures (Formerly EHR Measures)

Medicare Part B Claims*

CMS Web Interface

CAHPS for MIPS Survey

Administrative Claims

*Medicare Part B claims measures can only be submitted by clinicians in a small practice (15 or fewer eligible clinicians) whether participating individually or as part of a group.

What contributes to the Quality performance category score?

As Quality is worth 45% of your total MIPS composite performance score, understanding how to excel in this category is important. Measure performance compared to benchmarks, bonus points, performance improvement, and the small practice bonus will all impact your Quality score.

PERFORMANCE

  • 1-10 Points per reported measure

+

BONUS

  • Additional Outcome/ High-Priority Measures
  • End-to-end electronic reporting
  • Small Practice Bonus
  • Performance Improvement

  • Add together points scored and divide by 60 or 70 (for groups eligible for the All-Cause Hospital Readmission measure) to get the final quality score.  (This does not apply for EMA-eligible practices.)
  • If less than 6 measures are selected, clinicians will receive 0 points for missing measures.
  • Quality measures that meet the minimum case requirement (20 eligible instances), 60% data completeness threshold, and have a benchmark will be worth between 3-10 points.
  • If a measure has no benchmark or does not meet the minimum case requirement, it will only receive 3 points.  If a measure does not meet the data completeness threshold of 70%, it will only receive 0  point or 3 points (small practices).     
  • Bonus point categories are capped at 10% of the total possible quality score. This is 7 points for groups eligible for the All-Hospital Readmission Measure, and 6 points in all other circumstances.

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