2026 #410 MIPS Measure Psoriasis: Clinical Response to Systemic Medications

2026 COLLECTION TYPE:

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

‌MEASURE TYPE:

Intermediate Outcome – High Priority

‌DESCRIPTION:

Percentage of psoriasis vulgaris patients receiving systemic medication who meet minimal physician-or patient- reported disease activity levels. It is implied that establishment and maintenance of an established minimum level of disease control as measured by physician-and/or patient-reported outcomes will increase patient satisfaction with and adherence to treatment.

‌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 psoriasis vulgaris. 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 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-intermediate measure is submitted a minimum of once per patient during the performance period. The most recent 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 psoriasis vulgaris and treated with a systemic medication.

‌DENOMINATOR NOTE:

For this measure, the patient must ONLY be diagnosed with psoriasis vulgaris (L40.0) and no other concurrent psoriasis diagnosis. Therefore, patients meet criteria when they have been diagnosed with psoriasis vulgaris AND are on a systemic medication PRESCRIBED BY THE PROVIDER BEING EVALUATED FOR THE MEASURE.

*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):

All patients, regardless of age

AND

Diagnosis for psoriasis vulgaris (ICD-10-CM): L40.0

AND

Patient encounter during the performance period (CPT or HCPCS): 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99424, 99426, G0438, G0439

AND

Patient has been treated with a systemic medication for psoriasis vulgaris: G9764

Reference Medications:

Denominator Criteria for Systemic Medication [G9764] may be defined by the following examples, however, other medications that meet the intent of this component may also be used:

‌NUMERATOR:

Patients who have a documented physician global assessment (PGA; 5-point OR 6-point scale), body surface area (BSA), psoriasis area and severity index (PASI) and/or dermatology life quality index (DLQI) that meet any one of the below specified benchmarks.

‌Definition:

Consecutive Months – The consecutive treatment allows gaps in the medication treatment up to a total of 4 weeks during the 6 month period. Gaps can include periods in which the patient is changing or refilling medication, but regardless of the number of gaps, the total cannot be for more than 4 weeks.

‌Numerator Instructions:

To satisfy this measure, a patient must achieve any ONE of the following:

• PGA (5-point OR 6-point scale) ≤ 2 (clear to mild skin disease)
• BSA < 3% (mild disease)
• PASI < 3 (no or minimal disease)
• DLQI ≤ 5 (no effect or small effect on patient’s quality of life)

‌NUMERATOR NOTE:

For Denominator Exception(s), patients are ineligible for this measure if at the time of encounter there are patient or medical reason(s) for not meeting specified benchmarks (e.g. patient declined change in medication, patient experience adverse effects, etc.) as further specified below.

‌Numerator Options:‌

Performance Met: Psoriasis assessment tool documented meeting anyone of the specified benchmarks (e.g., (PGA; 5-point OR 6- point scale), body surface area (BSA), psoriasis area and severity index (PASI) and/or dermatology life quality index (DLQI)) (G9649)

‌OR

Denominator Exception: Documentation that the patient declined change in medication or alternative therapies were unavailable, has documented contraindications, or has not been treated with a systemic medication for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by PGA, BSA, PASI, or DLQI (G9765)

‌OR

Performance Not Met: Psoriasis assessment tool documented not meeting any one of the specified benchmarks (e.g., (PGA; 5-point OR 6-point scale), body surface area (BSA), psoriasis area and severity index (PASI) and/or dermatology life quality index (DLQI)) or psoriasis assessment tool not documented (G9651)

RATIONALE:

A significant proportion of psoriasis patients who are receiving treatment remain unsatisfied with their therapies due to various reasons including lack of or loss of efficacy, side effects, and inconvenience, among others. Treatment dissatisfaction also contributes to patients discontinuing their medication. This measure evaluates the proportion of psoriasis vulgaris patients receiving systemic medication who meet minimal physician or patient-reported disease activity levels. It is implied that establishment and maintenance of an established minimum level of disease control as measured by physician and/or patient-reported outcomes will increase patient satisfaction with and adherence to treatment.