2026 #303 MIPS Measure Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery

‌2026 COLLECTION TYPE:

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

‌MEASURE TYPE:

Patient-Reported Outcome-Based Performance Measure – High Priority

‌DESCRIPTION:

Percentage of patients aged 18 years and older who had cataract surgery and had improvement in visual function achieved within 90 days following the cataract surgery, based on completing a pre-operative and post-operative visual function survey.

‌INSTRUCTIONS:

Reporting Frequency:

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

‌Intent and Clinician Applicability:

‌This measure is intended to reflect the quality of services provided for the patient receiving cataract surgery.

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. This is an outcome measure and will be calculated solely using the Merit-based Incentive Payment System (MIPS) eligible clinician, group, or third-party intermediary submitted data.

• For patients who receive the cataract surgical procedures specified in the denominator coding, it should be submitted whether or not the patient had improvement in visual function achieved within 90 days following the cataract surgery.
• Only procedures performed between January 1st and September 30th of the performance period are eligible for the denominator. This will allow the post-operative period to occur before third-party intermediaries must submit data to CMS.
• It is the responsibility of the third-party intermediary to collate and score the surveys.

‌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 patients aged 18 years and older who had cataract surgery.

Denominator Criteria (Eligible Cases):

Patients aged ≥ 18 years on date of encounter

AND

Patient procedure during the performance period (CPT): 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984, 66987, 66988

WITHOUT

Modifier: 55 or 56

‌NUMERATOR:

Patients 18 years and older who had improvement in visual function achieved within 90 days following cataract surgery, based on completing a pre-operative and post-operative visual function survey.

NUMERATOR NOTE:

Denominator Exception(s) are determined within 90 days of the date of the denominator eligible procedure.

Numerator Options:

Performance Met: Improvement in visual function achieved within 90 days following cataract surgery (G0913)

OR

Denominator Exception: Patient care survey was not completed by patient (G0914)

OR

Performance Not Met: Improvement in visual function not achieved within 90 days following cataract surgery (G0915)

RATIONALE:

Scientific Basis for Measuring Visual Function Outcomes after Cataract Surgery. Visual function has been described as having multiple components, including central near, intermediate, and distance visual acuity; peripheral vision; visual search; binocular vision; depth perception; contrast sensitivity; perception of color; adaptation; and visual processing speed. Visual function also can be measured in terms of functional disability caused by visual impairment. Many activities are affected by more than one of these visual components