2026 #249 MIPS Measure Barrett’s Esophagus

2026 COLLECTION TYPE:

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

‌MEASURE TYPE:

Process

‌DESCRIPTION:

Percentage of esophageal biopsy reports that document the presence of Barrett’s mucosa that also include a statement about dysplasia.

‌INSTRUCTIONS:

‌Reporting Frequency:

This measure is to be submitted for each procedure that is denominator eligible as defined in the denominator criteria.

‌Intent and Clinician Applicability:

The intent of this measure is to assess esophageal biopsy reports indicating Barrett’s Esophagus for a statement regarding presence or absence of dysplasia and grading. 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 purposes of MIPS implementation, this procedure measure is submitted each time a procedure is performed during the performance period. Only one quality data code (QDC) (or equivalent) per date of procedure for each patient is required.

‌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 surgical pathology esophageal biopsy reports for Barrett’s Esophagus.

Denominator Criteria (Eligible Cases):

Diagnosis for Barrett’s Esophagus (ICD-10-CM): K22.70, K22.710, K22.711, K22.719

AND

Patient procedure during the performance period (CPT): 88305

‌NUMERATOR:

Esophageal biopsy report documents the presence of Barrett’s mucosa and includes a statement about dysplasia.

Numerator Options:

Performance Met: Esophageal biopsy reports with the histological finding of Barrett’s mucosa that contains a statement about dysplasia (present, absent, or indefinite and if present, contains appropriate grading) (3126F)

OR

Denominator Exception: Documentation of medical reason(s) for not submitting the histological finding of Barrett’s mucosa (e.g., malignant neoplasm or absence of intestinal metaplasia) (3126F with 1P)

OR

Denominator Exception: Specimen site other than anatomic location of esophagus (G8797)

OR

Performance Not Met: Pathology report with the histological finding of Barrett’s mucosa that does not contain a statement about dysplasia (present, absent, or indefinite, and if present, contains appropriate grading), reason not otherwise specified (3126F with 8P)

RATIONALE

Endoscopy is the technique of choice used to identify suspected Barrett’s esophagus and to diagnose complications of GERD. Biopsy must be added to confirm the presence of Barrett’s epithelium and to evaluate for dysplasia (ACG, 2022; AGA, 2011).
There is a rapidly rising incidence of adenocarcinoma of the esophagus in the United States. A diagnosis of Barrett’s esophagus increases a patient’s risk for esophageal adenocarcinoma by 30 to 125 times that of people without Barrett’s esophagus (although this risk is still small 0.4% to 0.5% per year) ( (Vincenza Conteduca, 2012). Esophageal adenocarcinoma is often not curable, partly because the disease is frequently discovered at a late stage and because treatments are not effective. A diagnosis of Barrett’s esophagus could allow for appropriate screening of at risk patients as recommended by the American College of Gastroenterology.
Standard endoscopy with biopsy currently is the most reliable means of establishing a diagnosis of Barrett’s esophagus. The definitive diagnosis of Barrett’s esophagus requires a pathologist’s review of an esophageal biopsy. Dysplasia is the first step in the neoplastic process, and information about dysplasia is crucial for clinical decision-making directing therapy. The presence and grade of dysplasia cannot be determined by routine endoscopy, and pathologist’s review of a biopsy is essential for recognition of dysplasia, especially given that there are no recommended biomarkers for Barrett’s esophagus. Endoscopic surveillance detects curable neoplasia in patients with Barrett’s esophagus (AGA 2025).