2026 #386 MIPS Measure Amyotrophic Lateral Sclerosis (ALS) Patient Care Preferences

‌2026 COLLECTION TYPE:

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

‌MEASURE TYPE:

Process – High Priority

‌DESCRIPTION:

Percentage of patients diagnosed with Amyotrophic Lateral Sclerosis (ALS) who were offered assistance in planning for end of life issues (e.g., advance directives, invasive ventilation, lawful physician-hastened death, or hospice) or whose existing end of life plan was reviewed or updated at least once annually or more frequently as clinically indicated (i.e., rapid progression).

‌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 Clinician Applicability:

This measure is intended to reflect the quality of services provided for patients with diagnosed with Amyotrophic Lateral Sclerosis (ALS). This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding. This measure is appropriate for use in outpatient and long-term care (e.g., nursing home, ambulatory). For each of these settings, there should be documentation in the medical record(s) that advance care planning was discussed or documented.

‌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 during the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.

‌Telehealth:

TELEHEALTH ELIGIBLE: This measure is appropriate for and applicable to the telehealth setting. Patient encounters conducted via telehealth using encounter code(s) found in the denominator encounter criteria are allowed for this measure. Therefore, if the patient meets all denominator criteria for a telehealth encounter, it would be appropriate to include them in 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 with a diagnosis of Amyotrophic Lateral Sclerosis (ALS).

‌DENOMINATOR NOTE:

*Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.

‌Denominator Criteria (Eligible Cases):

Diagnosis for Amyotrophic Lateral Sclerosis (ICD-10-CM): G12.21, G12.22, G12.23, G12.24, G12.25

AND

Patient encounter during the performance period (CPT): 92521, 92522, 92523, 92524, 92597, 92605, 92607, 92610, 92611, 92612, 92616, 96105, 96125, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99421, 99422, 99423, 99483

AND NOT

DENOMINATOR EXCLUSION:

Patient in hospice at any time during the measurement period: G9758

‌NUMERATOR:

Patients who were offered assistance in planning for end of life issues or whose existing end of life plan was reviewed or updated at least once annually or more frequently as clinically indicated (i.e., rapid progression).

‌Definition:

Assistance with end of life issues – assessment of patient concerns, desires and needs relating to end of life issues. Based on patient’s disease progression this may include discussions regarding invasive ventilation, advance directives, lawful physician hastened death, or hospice.

‌Numerator Options:‌

Performance Met: Patient offered assistance with end of life issues or existing end of life plan was reviewed or updated during the measurement period (G9380)

OR

‌Performance Not Met: Patient not offered assistance with end of life issues or existing end of life plan was not reviewed or updated during the measurement period (G9382)

RATIONALE:

Since it was released in 2013, the quality measure has been adopted by the Centers for Medicare & Medicaid Services in their Quality Payment Program. The measure has not been identified as topped-out. The measure was also implemented in the American Academy of Neurology Institute’s (AANI) Axon Registry®, and review of average performance scores indicated a continued gap in care: the 2018 average performance, excluding zero denominator from 8 clinicians, was 53.59%; the 2019 average performance, excluding zero denominator from 149 clinicians, was 48.8%; and the 2020 average performance, excluding zero denominator from 105 clinicians, was 73.92%. Evidence supports there is a continued gap to address for inpatient and outpatient clinicians.1-5
Clinical practice guidelines continue to stress the importance of end of life planning for patients with ALS and their care partners, but guidelines for discussions about end-of-life care for patients with ALS have not been published.1,6,7 In 2022, the AANI released a position statement, Clinical Guidance in Neuropalliative Care, that encourages clinicians to engage in neuropalliative planning at an early stage, given the poor prognosis and likelihood of difficulty expressing a desire to shift the focus of care as the disease progresses.8