2026 #405 MIPS Measure Appropriate Follow-up Imaging for Incidental Abdominal Lesions

‌2026 COLLECTION TYPE:

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

‌MEASURE TYPE:

Process – High Priority

‌DESCRIPTION:

Percentage of final reports for imaging studies for patients aged 18 years and older with one or more of the following noted incidentally with a specific recommendation for no follow-up imaging recommended based on radiological findings:

• Cystic renal lesion that is simple appearing* (Bosniak I or II)
• Adrenal lesion less than or equal to 1.0 cm
• Adrenal lesion greater than 1.0 cm but less than or equal to 4.0 cm classified as likely benign or diagnostic benign by unenhanced CT or washout protocol CT, or MRI with in- and opposed-phase sequences or other equivalent institutional imaging protocols

‌INSTRUCTIONS:‌

Reporting Frequency:

This measure is to be submitted each time a denominator eligible procedure as defined in the denominator criteria is performed.

‌Intent and Clinical Applicability:

This measure is intended to reflect the quality of services provided for patients aged 18 years and older who have an incidental finding of an abdominal lesion on an imaging study during the performance period. The intent of this measure is to ensure patients with incidental findings that are highly likely to be benign do not receive follow up imaging routinely.

There is no diagnosis associated with this measure. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who provide the professional component of diagnostic imaging studies will submit this measure. This measure may be submitted by 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.

‌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 final reports for imaging studies for patients aged 18 years and older with one or more of the following incidentally noted:

• Cystic renal lesion that is simple appearing (Bosniak I or II)

or

• Adrenal lesion less than or equal to 1.0 cm or
• Adrenal lesion greater than 1.0 cm but less than or equal to 4.0 cm classified as likely benign or diagnostic benign by unenhanced CT or washout protocol CT, or MRI with in- and opposed-phase sequences or other equivalent institutional imaging protocols

‌Definition:

*Simple-appearing criteria –

• • Incidental renal mass on non-contrast enhanced abdominal CT that does not contain fat, is homogenous in appearance, -10-20 HU or ≥70 HU. (American College of Radiology (ACR), 2017)
  • Incidental renal mass on contrast-enhanced abdominal CT that does not contain fat, is homogenous in appearance, -10-20 HU. (American College of Radiology (ACR), 2017)

‌DENOMINATOR NOTE:

When reporting this measure, masses and lesions that do not meet all the criteria for “no further work-up” as provided in Management of the Incidental Renal Mass on CT: A White Paper of the ACR Incidental Findings Committee (American College of Radiology (ACR), 2017) or the Management of the Incidental Adrenal Mass on CT: A White Paper of the ACR Incidental Findings Committee (American College of Radiology (ACR), 2017) should not be considered in the context or intent of this measure. However, generally accepted radiology practices should be followed with respect to communication and management of any characteristically benign findings. A measure performance goal of 100% should not substitute for clinical judgment in individual cases.

‌Denominator Criteria (Eligible Cases):

Patients aged ≥ 18 years on date of encounter

AND

Patient procedure during the performance period (CPT): 71250, 71260, 71270, 71271, 71275, 71555, 72131, 72191, 72192, 72193, 72194, 72195, 72196, 72197, 72198, 74150, 74160, 74170, 74176, 74177, 74178, 74181, 74182, 74183

AND

Incidental finding: Cystic renal lesion that is simple appearing (Bosniak I or II), or Adrenal lesion less than or equal to 1.0 cm or Adrenal lesion greater than 1.0 cm but less than or equal to 4.0 cm classified as likely benign by unenhanced CT or washout protocol CT, or MRI with in- and opposed-phase sequences or other equivalent institutional imaging protocols: G9547

‌NUMERATOR:

Final reports for imaging studies that include a description of incidental cystic renal lesion or adrenal lesion stating follow-up imaging is not recommended.

‌Numerator Instructions:

A short note can be made in the final report, such as:

• • “No follow-up imaging is recommended as incidental lesions are likely benign” or
  • “No follow-up imaging is recommended per consensus recommendations based on imaging criteria.

Further lab evaluation could be pursued based on clinical findings.”

‌Numerator Options:

‌Performance Met: Final reports for imaging studies stating no follow-up imaging is recommended (G9548)

OR

‌Denominator Exception: Documentation of medical reason(s) that follow-up imaging is indicated (e.g., patient has lymphadenopathy, signs of metastasis or an active diagnosis or history of cancer, and other medical reason(s)) (G9549)

OR

‌Performance Not Met: Final reports for imaging studies with follow-up imaging recommended, or final reports that do not include a specific recommendation of no follow-up (G9550)

RATIONALE:

Incidental renal and adrenal lesions are commonly found during imaging studies where the abdomen can be viewed, with most of the findings being benign. Given the low rate of malignancy, unnecessary follow-up procedures are costly and present a significant burden to patients. To avoid excessive testing and costs, follow-up is not recommended for these small lesions.