2026 #335 MIPS Measure Maternity Care: Elective Delivery (Without Medical Indication) at < 39 Weeks (Overuse)

‌2026 COLLECTION TYPE:

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

‌MEASURE TYPE:

Outcome – High Priority

• INVERSE MEASURE: LOWER SCORE – BETTER

‌DESCRIPTION:

Percentage of patients, regardless of age, who gave birth during a 12-month period, delivered a live singleton at < 39 weeks of gestation, and had elective deliveries (without medical indication) by cesarean birth or induction of labor.

‌INSTRUCTIONS:

‌Reporting Frequency:

This measure is to be submitted each time a procedure is performed for denominator eligible cases as defined in the denominator criteria patients seen during the performance period.

‌Intent and Clinician Applicability:

This measure is intended to reflect the quality of services provided for patients undergoing delivery by cesarean birth or induction of labor. 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.

This is an inverse measure which means a lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.

‌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, regardless of age, who gave birth during a 12-month period delivering a live singleton at < 39 weeks of gestation.

‌Denominator Criteria (Eligible Cases):

All patients, regardless of age

AND

Single live birth during the performance period (ICD-10-CM): Z37.0

AND

Patient procedure during performance period (CPT): 59400, 59409, 59410, 59510, 59514, 59515, 59610, 59612, 59614, 59618, 59620, 59622

AND

Delivery at < 39 weeks of gestation: M1444

‌NUMERATOR:

Patients who had elective deliveries (without medical indication) by cesarean birth or induction of labor.

‌Numerator Instructions:

INVERSE MEASURE – see Implementation Considerations

‌Numerator Options:

‌Performance Not Met: Elective delivery (without medical indication) by cesarean birth or induction of labor not performed (< 39 weeks of gestation) (G9355)

‌OR

Denominator Exception: Medical indication for delivery by cesarean birth or induction of labor (< 39 weeks of gestation) [Documentation of reason(s) for elective delivery (e.g., hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes (premature or prolonged), maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in clinical trial)] (G9361)

OR 

‌Performance Met: Elective delivery (without medical indication) by cesarean birth or induction of labor performed (< 39 weeks of gestation) (G9356)

RATIONALE:

Elective delivery or early induction often leads to prematurity, increased costs, and an increased incidence of cesarean birth. Studies have determined that elective delivery prior to the gestational age of 39 weeks may result in significant shortterm neonatal morbidity (neonatal intensive care unit admission rates of 13%–21%). Recent research shows that infants born prior to 39 weeks face a higher risk of breathing disorders and other problems than those who remain in the uterus longer.