2026 #416 MIPS Measure Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients Aged 2 Through 17 Years

2026 COLLECTION TYPE:

MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) CLINICAL QUALITY MEASURES (CQMs)

‌MEASURE TYPE: Efficiency – High Priority

• INVERSE MEASURE: LOWER SCORE – BETTER

‌Description:

Percentage of emergency department visits for patients aged 2 through 17 years who presented with a minor blunt head trauma who had a head CT for trauma ordered by an emergency care provider who are classified as low risk according to the Pediatric Emergency Care Applied Research Network (PECARN) prediction rules for traumatic brain injury.

‌Instructions:

Reporting Frequency:
This measure is to be submitted for each denominator eligible visit for denominator eligible cases as defined in the denominator criteria.

Intent and Clinical Applicability:
The intent of this measure is to assess appropriate use of head CT for patients aged 2 through 17 years who present to the emergency department with a minor blunt head trauma. 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 of this measure, this visit measure is submitted each time a patient is seen by the individual MIPS eligible clinician during the performance period. This 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 ELIGIBILE: 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 emergency department visits for patients aged 2 through 17 years who presented with a minor blunt head trauma who had a head CT for trauma ordered by an emergency care provider*.

Definitions:

Minor Blunt Head Trauma – Includes only non-penetrating injuries.

DENOMINATOR NOTE: *This measure looks to determine if an emergency care provider ordered head CT services typically provided under CPT code 70450.

Denominator Criteria (Eligible Cases):

Patients aged 2 through 17 years on date of encounter

AND

Diagnosis for minor blunt head trauma (ICD-10-CM): S00.03XA, S00.33XA, S00.431A, S00.432A, S00.439A, S00.531A, S00.532A, S00.83XA, S00.93XA, S06.A0XA, S06.A1XA, S06.0XAA, S06.0X0A, S06.0X1A, S06.0X9A, S06.1XAA, S06.1X0A, S06.1X1A, S06.1X2A, S06.1X3A, S06.1X4A, S06.1X9A, S06.2XAA, S06.2X0A, S06.2X1A, S06.2X2A, S06.2X3A, S06.2X4A, S06.2X9A, S06.30AA, S06.300A, S06.301A, S06.302A, S06.303A, S06.304A, S06.309A, S06.31AA, S06.32AA, S06.33AA, S06.34AA, S06.340A, S06.341A, S06.342A, S06.343A, S06.344A, S06.349A, S06.35AA, S06.350A, S06.351A, S06.352A, S06.353A, S06.354A, S06.359A, S06.36AA, S06.360A, S06.361A, S06.362A, S06.363A, S06.364A, S06.369A, S06.37AA, S06.38AA, S06.4XAA, S06.4X0A, S06.4X1A, S06.4X2A, S06.4X3A, S06.4X4A, S06.4X9A, S06.5XAA, S06.5X0A, S06.5X1A, S06.5X2A, S06.5X3A, S06.5X4A, S06.5X9A, S06.6XAA, S06.6X0A, S06.6X1A, S06.6X2A, S06.6X3A, S06.6X4A, S06.6X9A, S06.81AA, S06.810A, S06.811A, S06.812A, S06.813A, S06.814A, S06.819A, S06.82AA, S06.820A, S06.821A, S06.822A, S06.823A, S06.824A, S06.829A, S06.89AA, S06.890A, S06.891A, S06.892A, S06.893A, S06.894A, S06.899A, S06.9XAA, S06.9X0A, S06.9X1A, S06.9X2A, S06.9X3A, S06.9X4A, S06.9X9A, S09.11XA, S09.19XA, S09.8XXA

AND

Patient encounter during the performance period (CPT): 99281, 99282, 99283, 99284, 99285, 99291

WITHOUT

Encounters conducted via telehealth: M1426

AND

Patient presented with a minor blunt head trauma and had a head CT ordered for trauma by an emergency care provider: G9594

AND NOT

DENOMINATOR EXCLUSION:

Patient has documentation of ventricular shunt, brain tumor, or coagulopathy: G9595

‌Numerator:

Emergency department visits for patients who are classified as low risk according to the PECARN prediction rules for traumatic brain injury

Definition:

Low Risk for Traumatic Brain Injury according to PECARN prediction rules – Patients can be classified as low risk if ALL of the following are met:

• No signs of altered mental status (e.g., agitation, somnolence, repetitive questioning, slow response to verbal communication) OR no GCS < 15
• No signs of basilar skull fracture (signs include haemotympanum, “raccoon” eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign)
• No loss of consciousness
• No vomiting
• No severe mechanism of injury (i.e., motor vehicle crash with patient ejection, death of another passenger, or rollover; pedestrian or bicyclist without helmet struck by a motorized vehicle; falls of more than 5 feet; or head struck by a high-impact object)
• No severe headache

Numerator Options:

Performance Not Met: Pediatric patient with minor blunt head trauma not classified as low risk according to the PECARN prediction rules (G9597)

OR

Performance Met: Pediatric patient with minor blunt head trauma classified as low risk according to the PECARN prediction rules (G9593)

OR

Performance Met: Pediatric patient with minor blunt head trauma and PECARN prediction criteria are not assessed (G0047)

RATIONALE:

Though it is difficult to directly attribute the effects of smaller dosages of radiation, there is evidence to suggest that the low dose radiation emitted through the use of some CT scans is associated with a small, but cumulative risk of radiationinduced cancer, particularly in children (Frush, 2003). As over 1.3 million individuals are treated and released from the ED for mild traumatic brain injury annually, it is critical that CT scans only be utilized when clinically appropriate (Melnick, 2012). Through measurement of the share of CT scans that are performed inappropriately, a focus can be brought to quality improvement and increased application of clinical decision tools around this topic.

This measure is an overuse measure – its intention is to capture those instances in which a pediatric patient is characterized as low risk yet still receives a CT. As such, the measure is scored such that a lower score indicates better quality. The measure is constructed in this manner due to the available evidence; the PECARN clinical policy defines the low-risk population, but does not clearly define the medium and high risk populations. The measure then uses the definable population as its numerator, necessitating an “overuse” construction.