2026 # 052 MIPS Measure Chronic Obstructive Pulmonary Disease (COPD): Long-Acting Inhaled Bronchodilator Therapy

‌2026 COLLECTION TYPE:

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

‌MEASURE TYPE:

Process

‌DESCRIPTION:

Percentage of patients aged 18 years and older with a diagnosis of COPD with a documented FEV1/FVC < 70% measured by spirometry, who are symptomatic, and were prescribed a long-acting inhaled bronchodilator.

‌INSTRUCTIONS:

‌Reporting Frequency:

This measure is to be submitted a minimum of once per performance period for denominator eligible cases as defined the denominator criteria.

‌Intent and Clinician Applicability:

This measure is intended to reflect the quality of services provided for patients with COPD. 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:

There are 2 Submission Criteria for this measure:

1. Patients diagnosed with COPD who have documented airflow obstruction (FEV1/FVC < 70%) as measured by spirometry in the medical record.

AND

1. Patients diagnosed with COPD who have documented airflow obstruction (FEV1/FVC < 70%) and are symptomatic, who were prescribed a long-acting bronchodilator.

This measure contains two submission criteria which together ensure that the proper evaluation and treatment is provided for patients with COPD and that patients without COPD are not provided inappropriate therapy. Submission Criteria 1 evaluates whether spirometry was performed for patients diagnosed with COPD and results confirming airflow obstruction are documented. Submission Criteria 2 evaluates whether a long-acting inhaled bronchodilator was prescribed for COPD patients who have symptoms.

This measure will be calculated with 2 performance rates:

1. Percentage of patients aged 18 years and older with a diagnosis of COPD who have a documented airflow obstruction (FEV1/FVC < 70%) as measured by spirometry.
2. Percentage of patients aged 18 years and older with a diagnosis of COPD who have documented airflow obstruction (FEV1/FVC < 70%) and are symptomatic, who were prescribed a long-acting inhaled bronchodilator.

Submission of the two performance rates is required for this measure. A simple average, which is the sum of the performance rates divided by the number of the performance rates will be used to calculate 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.

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.

‌SUBMISSION CRITERIA 1: PATIENTS DIAGNOSED WITH COPD WHO HAVE DOCUMENTED AIRFLOW OBSTRUCTION (FEV1/FVC < 70%) AS MEASURED BY SPIROMETRY IN THE MEDICAL RECORD.

‌DENOMINATOR (CRITERIA 1):

All patients aged 18 and older with a diagnosis of COPD.

Denominator Criteria 1 (Eligible Cases):

Patients aged ≥ 18 years on date of encounter

AND

Diagnosis for COPD (ICD-10-CM): J41.0, J41.1, J41.8, J42, J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, J44.89, J44.9

AND

Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99424, 99426

WITHOUT

Encounters conducted via telehealth: M1426

‌NUMERATOR (CRITERIA 1):

Patients with documented spirometry and confirmed airflow obstruction (FEV1/FVC < 70%).

Numerator Instructions:

Documentation of spirometry results of (FEV1/FVC < 70%) can take place before the performance period. The intent of Submission Criteria 1 is to ensure accurate diagnosis of COPD in patients with respiratory symptoms such as dyspnea, chronic cough or sputum production, and/or a history of exposure to risk factors for the disease is appropriate by having documentation of spirometry results of FEV1/FVC < 70%, which is required to make the COPD diagnosis.

NUMERATOR NOTE:

Denominator Exception(s) are determined on the date of the denominator eligible encounter. If there is a diagnosis of COPD, but there is no documented spirometry within five years of the date of the encounter, and the current spirometry result is ≥ 70%, an exception may be reported.

Numerator Options:

Performance Met: Spirometry results with confirmed airflow obstruction (FEV1/FVC < 70%) documented and reviewed (M1214)

OR

Denominator Exception: Documentation of medical reason(s) for not documenting and reviewing spirometry results (e.g., patients with dementia or tracheostomy) (M1215)

OR

Denominator Exception: No history of spirometry results with confirmed airflow obstruction (FEV1/FVC < 70%) and present spirometry is ≥ 70% (M1213)

OR

Denominator Exception: Documentation of system reason(s) for not documenting and reviewing spirometry results (e.g., spirometry equipment not available at the time of the encounter) (M1217)

OR

Performance Not Met: No spirometry results with confirmed airflow obstruction (FEV1/FVC < 70%) documented and/or no spirometry performed with results documented during the encounter (M1216)

AND

‌SUBMISSION CRITERIA 2: PATIENTS DIAGNOSED WITH COPD WHO HAVE DOCUMENTED AIRFLOW OBSTRUCTION (FEV1/FVC < 70%) AND ARE SYMPTOMATIC, WHO WERE PRESCRIBED A LONG-ACTING BRONCHODILATOR.

‌DENOMINATOR (CRITERIA 2):

All patients aged 18 years and older with a diagnosis of COPD with spirometry results documented (FEV1/FVC < 70%), and have symptoms (e.g., dyspnea, cough/sputum, wheezing).

Denominator Criteria 2 (Eligible Cases):

Patients aged ≥ 18 years on date of encounter

AND

Diagnosis for COPD (ICD-10-CM): J41.0, J41.1, J41.8, J42, J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, J44.89, J44.9

AND

Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99424, 99426

WITHOUT

Encounters conducted via telehealth: M1426

AND

Spirometry results documented (FEV1/FVC < 70%): G8924

AND

Patient has COPD symptoms (e.g., dyspnea, cough/sputum, wheezing): M1218

‌NUMERATOR (CRITERIA 2):

Symptomatic COPD patients who were prescribed a long-acting inhaled bronchodilator.

Definition:

Prescribed – Includes patients who were “prescribed” medication at an encounter during the performance period, even if the prescription for that medication was ordered prior to the encounter.

NUMERATOR NOTE:

Denominator Exception(s) are determined on the date of the denominator eligible encounter.

Numerator Options:

Performance Met: Long-acting inhaled bronchodilator prescribed (G9695)

OR

Denominator Exception: Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., patient intolerance or history of side effects) (G9696)

OR

Denominator Exception: Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., cost of treatment or lack of insurance) (G9698)

OR

Performance Not Met: Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified (G9699)

RATIONALE:

Despite major efforts to broadly disseminate the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines and use of COPD performance measures across different specialty societies, diagnosis and management of COPD, and specifically prescription for long-acting inhaled bronchodilators, remains suboptimal.