2026 #393 MIPS Measure Infection within 180 Days of Cardiac Implantable Electronic Device (CIED) Implantation, Replacement, or Revision

‌2026 COLLECTION TYPE:

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

‌MEASURE TYPE:

Outcome – High Priority

• INVERSE MEASURE: LOWER SCORE – BETTER

‌DESCRIPTION:

Infection rate following CIED device implantation, replacement, or revision.

‌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 who undergo CIED device implantation, replacement, or revision. 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.

‌Measure Strata and Performance Rates:

This measure contains two strata defined by two submission criteria.

This measure produces a single performance rate using a weighted average.

There are 2 Submission Criteria for this measure:

1. Patients, regardless of age, with a new CIED

OR

1. Patients, regardless of age, with a replaced or revised CIED

Additional submitting stratification categories may be useful; however, these stratifications are not required for purposes of QPP submission:

1. • Device class (e.g., pacemaker, ICD) and type (e.g., single chamber, dual chamber);
   • Advanced renal disease (CKD stages 4 and 5, ESRD);
   • Diabetes;
   • CIED infection requiring device removal within 180 days prior to index CIED procedures; and
   • CIED-related surgical procedure within 180 days prior to current CIED procedure.

‌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 QDC will be used if the measure is submitted more than once.

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.

Include only patients that have had CIED implantation, replacement, or revision performed by June 30, 2026. This timeframe allows for evaluation of infection required within 180 days within the performance period. This will allow the evaluation of infection status post CIED implantation, replacement, or revision within the performance period.

Infection rates for new implants shall be calculated and submitted separately from device replacements and revisions. A new device would be either the first device OR a device implanted with new functionality.

‌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.

SUBMISSION CRITERIA 1: PATIENTS WITH A NEW CIED

‌DENOMINATOR (CRITERIA 1):

All patients with a new CIED from January 1, 2026, through June 30, 2026, of the performance period.

‌Definition:

CIEDs encompassed for this measure are the following devices:

1. • Pacemaker devices (single or dual chamber);
   • Implantable cardioverter-defibrillators (ICDs, single or dual chamber);
   • Cardiac resynchronization devices (pacemaker or ICD); and
   • Implantable loop recorders (ILRs)

‌Denominator Criteria (Eligible Cases) 1:

All patients, regardless of age

AND

Procedure code for implantation, replacement, or revision of a CIED from January 1, 2026, through June 30, 2026, of the performance period (ICD-10-PCS): 0JH604Z, 0JH605Z, 0JH606Z, 0JH607Z, 0JH608Z, 0JH609Z, 0JH60PZ, 0JH634Z, 0JH635Z, 0JH636Z, 0JH637Z, 0JH638Z, 0JH639Z, 0JH63PZ, 0JH804Z, 0JH805Z, 0JH806Z, 0JH807Z, 0JH808Z, 0JH809Z, 0JH80PZ, 0JH834Z, 0JH835Z, 0JH836Z, 0JH837Z, 0JH838Z, 0JH83PZ, 0JPT0PZ, 0JPT3PZ, 0JWT0PZ, 0JWT3PZ

AND/OR

Patient encounter during performance period (CPT): 33202, 33203, 33206, 33207, 33208, 33212, 33213, 33214, 33215, 33216, 33217, 33218, 33220, 33221, 33222, 33223, 33224, 33226, 33227, 33228, 33229, 33240, 33249, 33262, 33263, 33264, 33270

AND

New CIED: M1454

AND NOT

DENOMINATOR EXCLUSION:

Patient had a heart transplant: M1456

Reference Coding:

Denominator Exclusion for Heart Transplant [M1456] is defined by the following coding only (ICD-10-PCS): 02YA0Z0, 02YA0Z1, 02YA0Z2

‌NUMERATOR (CRITERIA 1):

The number of patients from the denominator admitted with an infection requiring device removal or surgical revision within 180 days following CIED implantation, replacement, or revision.

Numerator Instructions:

INVERSE MEASURE – see Implementation Considerations

‌Numerator Options:

‌Performance Not Met: Patient not admitted within 180 days, status post CIED implantation, replacement, or revision with an infection requiring device removal or surgical revision (G9411)

OR

‌Performance Met: Patient admitted within 180 days, status post CIED implantation, replacement, or revision with an infection requiring device removal or surgical revision (G9410)

OR

‌SUBMISSION CRITERIA 2: PATIENTS WITH A REPLACED OR REVISED CIED DENOMINATOR (CRITERIA 2):

All patients with replacement or revision of a CIED from January 1, 2026, through June 30, 2026, of the performance period.

‌Definition:

CIEDs encompassed for this measure are the following devices:

1. • Pacemaker devices (single or dual chamber);
   • Implantable cardioverter-defibrillators (ICDs, single or dual chamber);
   • Cardiac resynchronization devices (pacemaker or ICD); and
   • Implantable loop recorders (ILRs)

‌Denominator Criteria (Eligible Cases) 2:

All patients, regardless of age

AND

Procedure code for implantation, replacement, or revision of a CIED from January 1, 2026, through June 30, 2026, of the performance period (ICD-10-PCS): 0JH604Z, 0JH605Z, 0JH606Z, 0JH607Z, 0JH608Z, 0JH609Z, 0JH60PZ, 0JH634Z, 0JH635Z, 0JH636Z, 0JH637Z, 0JH638Z, 0JH639Z, 0JH63PZ, 0JH804Z, 0JH805Z, 0JH806Z, 0JH807Z, 0JH808Z, 0JH809Z, 0JH80PZ, 0JH834Z, 0JH835Z, 0JH836Z, 0JH837Z, 0JH838Z, 0JH83PZ, 0JPT0PZ, 0JPT3PZ, 0JWT0PZ, 0JWT3PZ

AND/OR

Patient encounter during performance period (CPT): 33202, 33203, 33206, 33207, 33208, 33212, 33213, 33214, 33215, 33216, 33217, 33218, 33220, 33221, 33222, 33223, 33224, 33226, 33227, 33228, 33229, 33240, 33249, 33262, 33263, 33264, 33270

AND

Replaced or revised CIED: M1455

AND NOT

DENOMINATOR EXCLUSION:

Patient had a heart transplant: M1456

‌Reference Coding:

Denominator Exclusion for Heart Transplant [M1456] is defined by the following coding only (ICD-10-PCS): 02YA0Z0, 02YA0Z1, 02YA0Z2

‌NUMERATOR (CRITERIA 2):

The number of patients from the denominator admitted with an infection requiring device removal or surgical revision within 180 days following CIED implantation, replacement, or revision.

‌Numerator Instructions:

INVERSE MEASURE – see Implementation Considerations

‌Numerator Options:

‌Performance Not Met: Patient not admitted within 180 days, status post CIED implantation, replacement, or revision with an infection requiring device removal or surgical revision (G9413)

OR

‌Performance Met: Patient admitted within 180 days, status post CIED implantation, replacement, or revision with an infection requiring device removal or surgical revision (G9412)

RATIONALE:

The rate of implantable cardioverter-defibrillator (ICD) infections has been increasing faster than that of device implantation and is associated with substantial morbidity, mortality, and financial cost. A recent study including over 200,000 ICD implant patients found 2 percent of patients undergoing ICD implantation experienced a device-related infection. Patients who developed an ICD infection were likely to have more comorbidity burden, warfarin use, coronary sinus lead, device upgrade/malfunction as the last surgery, peri-ICD implant complications, and non-EP trained operator. The evidence demonstrates the need to measure performance in this area.