2026 #250 MIPS Measure Radical Prostatectomy Pathology Reporting

2026 COLLECTION TYPE:

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

MEASURE TYPE:

Process

DESCRIPTION:

Percentage of radical prostatectomy pathology reports that include the pT category, the pN category, the Gleason score and a statement about margin status.

‌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 Radical Prostatectomy reports for inclusion of the pT category, the pN category, Gleason score and a statement about margin status. 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. The most advantageous quality data code (QDC) submitted will be used for performance.

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 radical prostatectomy surgical pathology examinations performed during the measurement period for primary prostate cancer.

Denominator Criteria (Eligible Cases):

Diagnosis for malignant neoplasm of prostate (ICD-10-CM): C61

AND

Patient procedure during the performance period (CPT): 88309

AND NOT

DENOMINATOR EXCLUSION:

Specimen site other than anatomic location of prostate: G8798

NUMERATOR:

Radical Prostatectomy reports that include the pT category, the pN category, Gleason score and a statement about margin status.

Numerator Options:

Performance Met: Pathology report includes pT category, pN category, Gleason score and statement about margin status (3267F)

OR

Denominator Exception: Documentation of medical reason(s) for not including pT category, pN category, Gleason score and statement about margin status in the pathology report (e.g., specimen originated from other malignant neoplasms, transurethral resections of the prostate (TURP), or secondary site prostatic carcinomas) (3267F with 1P)

OR

Performance Not Met: pT category, pN category, Gleason score and statement about margin status were not documented in pathology report, reason not otherwise specified (3267F with 8P)

RATIONALE

Therapeutic decisions for prostate cancer management are stage driven and cannot be made without a complete set of pathology descriptors. Incomplete pathology reports for prostate cancer may result in misclassification of patients, rework and delays, and suboptimal management. The College of American Pathologists Cancer Committee has produced an evidence-based protocol/checklist of essential pathologic parameters that are recommended to be included in prostate cancer resection pathology reports. Conformance of pathology reports with the CAP checklist is a requirement for Cancer Center certification by the ACS.
The protocol recommends the use of the TNM Staging System for carcinoma of the prostate of the American Joint  Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) (AJCC, 2017). The radical prostatectomy checklist also includes extraprostatic extension.
In a study of cancer recurrence following radical prostatectomy, it was noted that “The relatively high proportion of patients who have biopsy-proven local recurrence who have organ-confined disease is probably inaccurate and, in large part, reflects under sampling and under recognition of extraprostatic extension” (Ripple et al 2000 Mod Path).
The CAP Q probes data (2006) indicate that 11.6% of prostate pathology reports had missing elements. Extent of invasion (pTNM) was most frequently missing (52.1% of the reports missing elements), and extraprostatic extension was the second most frequently missing (41.7% of the reports missing elements). Margin status was missing in 8.3% of reports. A sampling from prostate cancer cases in 2000 through 2001 from the College of Surgeons National Cancer Data Base found only 48.2% of surgical pathology reports for prostate cancer documented pathologic stage similar to the more recent data from the CAP Q probes study. The NCDB data showed the Gleason score was present 86.3% of the time, slightly less than the 100% compliance found in the CAP Q probes study and that margin status was present in 84.9% of reports.