2026 #396 MIPS Measure Lung Cancer Reporting (Resection Specimens)

2026 COLLECTION TYPE:

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

MEASURE TYPE:

Process – High Priority

DESCRIPTION:

Pathology reports based on lung resection specimens with a diagnosis of primary lung carcinoma that include the pT category, pN category and for non-small cell lung cancer (NSCLC), histologic type.

INSTRUCTIONS:

Reporting Frequency:

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

Intent and Clinician Applicability:

‌The intent of this measure is to assess that lung resection specimen pathology reports for patients with non-small cell lung cancer include the pT category, pN category and for non-small cell lung cancer, histologic type and NOT NSCLC-NOS. 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 purposes of MIPS implementation, this procedure measure is submitted each time a procedure is performed during the performance period. Only one quality data code (QDC) per date of service for a patient is required.

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:

Pathology reports for lung resection specimens for primary lung carcinoma.

Denominator Criteria (Eligible Cases): Patients ≥18 years of age on date of service

AND

Diagnosis for lung cancer (ICD-10-CM): C34.00, C34.01, C34.02, C34.10, C34.11, C34.12, C34.2, C34.30, C34.31, C34.32, C34.80, C34.81, C34.82, C34.90, C34.91, C34.92

AND

Patient procedure during performance period (CPT): 88309

AND NOT

DENOMINATOR EXCLUSION:

Specimen site other than anatomic location of lung, OR classified as NSCLC-NOS: G9424

NUMERATOR:

Pathology reports based on lung resection specimens with a diagnosis of primary lung carcinoma that include the pT category, pN category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma and NOT NSCLC-NOS (non-small cell lung cancer, not otherwise specified)).

Numerator Options:

Performance Met: Primary lung carcinoma resection report documents pT category, pN category and for Non-small Cell Lung Cancer, Histologic Type (e.g. Squamous Cell Carcinoma, Adenocarcinoma and NOT NSCLC- NOS) (G9422)

OR

Denominator Exception: Documentation of medical reason for not including pT category, pN category and histologic type [For patient with appropriate exclusion criteria (e.g. metastatic disease, benign tumors, malignant tumors other than carcinomas, inadequate surgical specimens)] (G9423)

OR

Performance Not Met: Primary lung carcinoma resection report does not document pT category, pN category and for Non- small Cell Lung Cancer, Histologic Type (e.g. Squamous Cell Carcinoma, Adenocarcinoma) (G9425)

RATIONALE:

The TNM staging revisions (AJCC 7th edition) became effective for all new cases diagnosed after January 1, 2010. The new staging system is applicable to both NSCLC and, for the first time, small cell lung cancer (SCLC). There are significant changes in staging, particularly in T3 for NSCLC. These updates were maintained in the AJCC 8th edition (2018). Recent evidence suggests that significant variability still exists among clinicians with respect to staging practices (Turner, SR 2018)