2026 #320 MIPS Measure Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients

2026 COLLECTION TYPE:

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

‌MEASURE TYPE:

Process – High Priority

‌DESCRIPTION:

Percentage of patients aged 45 to 75 years of age receiving a screening colonoscopy without biopsy or polypectomy who had a recommended follow-up interval of 10 years for repeat colonoscopy documented in their colonoscopy report.

‌INSTRUCTIONS:

‌Reporting Frequency:

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

‌Intent and Clinical Applicability:

This measure is intended to reflect the quality of services provided for patients aged 45 to 75 years of age who received a screening colonoscopy. Performance for this measure is not limited to the performance period. 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 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.

Patients who have a coded colonoscopy procedure that has a modifier 52, 53, 73, or 74 will not qualify for inclusion into the measure.

‌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.

‌DENOMINATOR:

All patients aged 45 to 75 years of age receiving a screening colonoscopy without biopsy or polypectomy.

‌Denominator Instructions:

MIPS eligible clinicians who indicate that the colonoscopy procedure is incomplete or was discontinued should use the procedure number and the addition (as appropriate) of modifier 52, 53, 73, or 74. Patients who have a coded colonoscopy procedure that has a modifier 52, 53, 73, or 74 will not qualify for inclusion into this measure.

‌Denominator Criteria (Eligible Cases):

Patients aged 45 to 75 on date of encounter

AND

Patient undergoing screening for malignant neoplasm of colon(ICD-10-CM): Z12.11

AND

Patient procedure during the performance period (CPT or HCPCS): 44388, 45378, G0121

WITHOUT

Modifiers: 52, 53, 73, or 74

‌NUMERATOR:

Patients who had recommended follow-up interval of 10 years for repeat colonoscopy documented in their colonoscopy report.

‌NUMERATOR NOTE:

To meet the numerator, patients with a negative screening colonoscopy should have documentation that they received counseling or instruction to have a follow-up or repeat colonoscopy in 10 years. A 6 month period before or after 10 years is considered within the recommended follow-up interval.

‌Numerator Options:

‌Performance Met: Recommended follow-up interval for repeat colonoscopy of 10 years documented in colonoscopy report and communicated with patient (M1377)

‌OR

Denominator Exception: Documentation of medical reason(s) for not recommending a 10-year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is ≥ 66 years old, or life expectancy < 10 years, other medical reasons) (M1378)

‌OR

Performance Not Met: A 10-year follow-up interval for colonoscopy not recommended, reason not otherwise specified (M1379)

RATIONALE:

In the average-risk population, colorectal cancer screening using colonoscopy is recommended in all current guidelines at 10- year intervals. Inappropriate interval recommendations can result in overuse of resources and can lead to significant patient harm and unnecessary healthcare expenditures. Performing colonoscopy too often not only increases patients’ exposure to procedural harm, but also drains resources that could be more effectively used to adequately screen those in need of more urgent colonoscopy (Lieberman et al, 2008).
Variations in the recommended time interval between colonoscopies exist for patients with normal colonoscopy findings. In a 2006 study of 1282 colonoscopy reports, recommendations were consistent with contemporaneous guidelines in only 39.2% of cases and with current guidelines in 36.7% of cases. Further, the adjusted mean number of years in which repeat colonoscopy was recommended was 7.8 years following normal colonoscopy (Krist et al, 2007).