2026 #145 MIPS Measure Radiology: Exposure Dose Indices Reported for Procedures Using Fluoroscopy

2026 COLLECTION TYPE:

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

‌MEASURE TYPE:

Process – High Priority

‌DESCRIPTION:

Final reports for procedures using fluoroscopy that document radiation exposure indices.

‌INSTRUCTIONS:

‌Reporting Frequency:

This measure is to be submitted each time a denominator eligible procedure as defined in the denominator criteria is performed.

‌Intent and Clinical Applicability:

This measure is intended to reflect the quality of services provided for patients who undergo a procedure using fluoroscopy. There is no diagnosis associated with this measure. 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, this procedure measure is submitted each time a procedure is performed during the performance period.

‌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:

All final reports for procedures using fluoroscopy.

‌DENOMINATOR NOTE:

The final report of the fluoroscopy procedure or fluoroscopy guided procedure includes the final radiology report, definitive operative report, or other definitive procedure report that is communicated to the referring physician, primary care physician, follow-up care team, and/or maintained in the medical record of the performing physician outside the EHR or other medical record of the facility in which the procedure is performed.

*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):

Patient procedure during the performance period (CPT or HCPCS): 0075T, 0202T, 0234T, 0235T, 0236T, 0237T, 0238T, 0338T, 0339T, 22526*, 25606, 25651, 26608, 26650, 26676, 26706, 26727, 27235, 27244, 27245, 27509, 27756, 27759, 28406, 28436, 28456, 28476, 33477, 33741, 33745, 33897, 33900, 33901, 33902, 33903, 34703, 34704, 34705, 34706, 34718, 34841, 34842, 34843, 34844, 34845, 34846, 34847, 34848, 36221, 36222, 36223, 36224, 36225, 36226, 36251, 36252, 36253, 36254, 36598, 36901, 36902, 36903, 36904, 36905, 36906, 37182, 37183, 37184, 37187, 37188, 37211, 37212, 37213, 37214, 37215, 37216*, 37217, 37218, 37236, 37238, 37241, 37242, 37243, 37244, 37246, 37248, 37254, 37256, 37258, 37260, 37263, 37265, 37267, 37269, 37271, 37273, 37275, 37277, 37280, 37282, 37284, 37286, 37288, 37290, 37292, 37294,37296, 37298, 43260, 43261, 43262, 43263, 43264, 43265, 43274, 43275, 43276, 43277, 43278, 43752, 47537, 49440, 49441, 49442, 49446, 49450, 49451, 49452, 49460, 50382, 50384, 50385, 50386, 50387, 50389, 61623, 61630, 61635, 61640*, 61645, 61650, 62263, 62264, 62280, 62281, 62282, 62302, 62303, 62304, 62305, 70010, 70015, 70170, 70332, 70370, 70371, 70390, 72240, 72255, 72265, 72270, 72285, 72295, 73040, 73085, 73115, 73525, 73580, 73615, 74210, 74220, 74221, 74235, 74240, 74246, 74251, 74270, 74280, 74300, 74328, 74329, 74330, 74340, 74355, 74360, 74363, 74425, 74440, 74445, 74450, 74470, 74485, 74742, 75600, 75605, 75625, 75630, 75705, 75710, 75716, 75726, 75731, 75733, 75736, 75741, 75743, 75746, 75756, 75801, 75803, 75805, 75807, 75810, 75825, 75827, 75831, 75833, 75840, 75860, 75870, 75872, 75880, 75885, 75887, 75889, 75891, 75893, 75894, 75898, 75901, 75902, 75970, 76000, 76080, 76496, 77001, 77002, 77003, 92611, 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93503, 93505, 93580, 93581, 93593, 93594, 93595, 93596, 93597, 93583

‌NUMERATOR:

Final reports for procedures using fluoroscopy that include radiation exposure indices.

‌Definition:

Radiation exposure indices – For the purposes of this measure, “radiation exposure indices” should include at least one of the following:

1. Reference air kerma (Ka,r) in Gy or mGy
2. Kerma-area product (PKA) or Dose area product (DAP) in uGy*m², mGy*cm² (or similar)
3. Peak skin dose (PSD) in Gy or mGy

When reporting indices the report must clearly state what radiation quantity is being submitted, that is only reporting dose in mGy is insufficient. PSD in mGy is very different from Ka,r in mGy. As an example, PSD = 10 mGy or Ka,r = 10 mGy would meet numerator performance, but “10 mGy” alone would not.

Note: When reporting reference air kerma or kerma-area product for biplane systems, the value should be reported as the sum of both planes (or the value for each plane should be reported individually).

‌Numerator Instructions:

Documentation: Dose information in the final report may be located in a variety of sources and should be available to the referring physician on receipt of report.

‌NUMERATOR NOTE:

In interventional radiology procedures with runs, dose indices are displayed on the console and in the radiation dose structured report (RDSR).

‌Numerator Options:‌

Performance Met: Radiation exposure indices documented in final report for procedure using fluoroscopy (G9500)

‌OR

Performance Not Met: Radiation exposure indices not documented in final report for procedure using fluoroscopy, reason not given (G9501)

RATIONALE

Increasing physician awareness of patient exposure to radiation is an important step towards reducing the potentially harmful effects of radiation as a result of imaging studies. Studies have shown that dose monitoring for fluoroscopy procedures has resulted in an overall reduction in patient radiation exposure. (RSNA, 2019) Proper identification and management of patients receiving high doses of radiation from fluoroscopy procedures are essential elements of patient care due to the slowly developing nature of radiation-induced tissue reactions. (AAPM, 2022)