2026 #482 MIPS Measure Hemodialysis Vascular Access: Practitioner Level Long-term Catheter Rate

2026 COLLECTION TYPE:

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

‌MEASURE TYPE: ‌Intermediate outcome – High Priority

• INVERSE MEASURE: LOWER SCORE – BETTER

Description:

Percentage of adult hemodialysis (HD) patient-months using a catheter continuously for three months or longer for vascular access attributable to an individual practitioner or group practice.

‌Instructions:

Reporting Frequency:
This measure is to be submitted a minimum of once per month for denominator eligible cases as defined in thedenominator criteria.

Intent and Clinician Applicability:
This measure is intended to reflect the quality of services provided for hemodialysis patients who used a catheter for three patient months or longer for vascular access as defined in End Stage Renal Disease (ESRD) Quality Reporting System (EQRS) (formerly known as CROWNWeb). 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-periodic measure is submitted a minimum of once per patient per timeframe specified by the measure for the performance period. The most advantageous quality data code (QDC) will be used if the measure is submitted more than once for the specified timeframe. If more than one QDC is submitted during the episode time period, performance rates shall be calculated by using the most advantageous QDC.

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.

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 ntermediaries 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 at least 18 years old as of the first day of the reporting month who are determined to be maintenance hemodialysis patients (in-center and home HD) for the complete reporting month under the care of the same practitioner or group partner

Definition:
Patient-months—The number of “patient-months” over a time period is the sum of patients reported for the months covered by the time period. An individual patient may contribute up to 12 “patient-months” per year.

DENOMINATOR NOTE:
Only clinicians who have been caring for adult hemodialysis patients for three months or longer should report this measure. Eligible patient months are attributed to one or more clinicians of a specialty that is eligible for MIPS. Only clinicians of a specialty that is eligible for MIPS or clinician groups where the triggering clinician is of a specialty that is eligible for MIPS are attributed episodes. This measure does not exclude patients who have exhausted their vascular access options.

Denominator Criteria (Eligible Cases):

All patients aged ≥18 years as of the first day of the reporting month

AND

With maintenance hemodialysis (in-center and home HD) for the complete reporting month: G0049

AND NOT

DENOMINATOR EXCLUSIONS:

Patients with a catheter that have limited life expectancy: G0050

OR

Patients under hospice care in the current reporting month: G0051

OR

Patients on Peritoneal Dialysis for any portion of the reporting month: G0052

OR

‌Patient-months where there are more than one Medicare capitated payment (MCP) provider listed for the month: G1025

Reference Coding:

Denominator Exclusion for Limited Life Expectancy [G0050] is defined by the following coding only: Metastatic Cancer C56.3, C77.0, C77.1, C77.2, C77.4, C77.5, C77.8, C78.00, C78.01, C78.02, C78.1, C78.2, C78.30, C78.39, C78.4, C78.5, C78.6, C78.7, C78.80, C78.89, C79.00, C79.01, C79.02, C79.10, C79.11, C79.19, C79.31, C79.32, C79.40, C79.49, C79.51, C79.52, C79.60, C79.61, C79.62, C79.63, C79.70, C79.71, C79.72, C79.89, C79.9, C7B.00, C7B.01, C7B.02, C7B.03, C7B.04, C7B.09, C7B.1, C7B.8, C80.0, C81.0A, C81.1A, C81.2A, C81.3A, C81.4A, C81.7A, C81.9A, C82.0A, C82.1A, C82.2A, C82.3A, C82.4A, C82.5A, C82.6A, C82.8A, C82.9A, C83.0A, C83.1A, C83.390, C83.398, C83.3A, C83.5A, C83.7A, C83.8A, C83.9A, C84.0A, C84.1A, C84.4A, C84.6A, C84.7A, C84.7B, C84.9A, C84.AA, C84.ZA, C85.1A, C85.2A, C85.8A, C85.9A, C86.00, C86.01, C86.10, C86.11, C86.20, C86.21, C86.30, C86.31, C86.40, C86.41, C86.50, C86.51, C86.60, C86.61, C88.00, C88.01, C88.20, C88.21, C88.30, C88.31, C88.40, C88.41, C88.80, C88.81, C88.90, C88.91, C91.00, C91.01, C91.02, C92.00, C92.01, C92.02, C92.40, C92.41, C92.42, C92.50, C92.51, C92.52, C92.60, C92.61, C92.62, C92.A0, C92.A1, C92.A2, C93.00, C93.01, C93.02, C94.00, C94.01, C94.02, C95.00, C95.01, C95.02, I31.31

End Stage Liver Disease
I85.00, I85.01, I85.10, I85.11, K70.41, K71.11, K72.01, K72.10, K72.11, K72.90, K72.91, K74.02, K76.6, K76.7, K76.81, K76.82, O90.41

Coma or Anoxic Brain Injury
E03.5, F01.511, F01.518, F01.52, F01.53, F01.54, F01.A0, F01.A11, F01.A18, F01.A2, F01.A3, F01.A4, F01.B0, F01.B11, F01.B18, F01.B2, F01.B3, F01.B4, F01.C0, F01.C11, F01.C18, F01.C2, F01.C3, F01.C4, F02.811, F02.818, F02.82, F02.83, F02.84, F02.A0, F02.A11, F02.A18, F02.A2, F02.A3, F02.A4, F02.B0, F02.B11, F02.B18, F02.B2, F02.B3, F02.B4, F02.C0, F02.C11, F02.C18, F02.C2, F02.C3, F02.C4, F03.911, F03.918, F03.92, F03.93, F03.94, F03.A0, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B0, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C0, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, G11.5, G11.6, G23.3, G31.80, G31.86, G37.81, G37.89, G40.841, G40.842, G40.843, G40.844, G40.C01, G40.C09, G40.C11, G40.C19, G90.B, G93.1, G93.42, G93.43, G93.44, G93.45, G93.5, G93.6, R40.20, R40.2110, R40.2111, R40.2112, R40.2113, R40.2114, R40.2120, R40.2121, R40.2122, R40.2123, R40.2124, R40.2210, R40.2211, R40.2212, R40.2213, R40.2214, R40.2220, R40.2221, R40.2222, R40.2223, R40.2224, R40.2310, R40.2311, R40.2312, R40.2313, R40.2314, R40.2320, R40.2321, R40.2322, R40.2323, R40.2324, R40.2340, R40.2341, R40.2342, R40.2343, R40.2344, R40.2A, R40.3, S06.1XAA, S06.1XAD, S06.1XAS, S06.1X0A, S06.1X1A, S06.1X2A, S06.1X3A, S06.1X4A, S06.1X5A, S06.1X6A, S06.1X7A, S06.1X8A, S06.1X9A, S06.2XAA, S06.2XAD, S06.2XAS, S06.30AA, S06.30AD, S06.30AS, S06.31AA, S06.31AD, S06.31AS, S06.32AA, S06.32AD, S06.32AS, S06.33AA, S06.33AD, S06.33AS, S06.34AA, S06.34AD, S06.34AS, S06.35AA, S06.35AD, S06.35AS, S06.36AA, S06.36AD, S06.36AS, S06.37AA, S06.37AD, S06.37AS, S06.38AA, S06.38AD,
S06.38AS, S06.4XAA, S06.4XAD, S06.4XAS, S06.5XAA, S06.5XAD, S06.5XAS, S06.6XAA, S06.6XAD, S06.6XAS, S06.81AA, S06.81AD, S06.81AS, S06.82AA, S06.82AD, S06.82AS, S06.89AA, S06.89AD, S06.89AS, S06.8A0A, S06.8A0D, S06.8A0S, S06.8A1A, S06.8A1D, S06.8A1S, S06.8A2A, S06.8A2D, S06.8A2S, S06.8A3A, S06.8A3D, S06.8A3S, S06.8A4A, S06.8A4D, S06.8A4S, S06.8A5A, S06.8A5D, S06.8A5S, S06.8A6A, S06.8A6D, S06.8A6S, S06.8A7A, S06.8A8A, S06.8A9A, S06.8A9D, S06.8A9S, S06.8AAA, S06.8AAD, S06.8AAS, S06.9XAA, S06.9XAD, S06.9XAS, S06.A0XA, S06.A0XD, S06.A0XS, S06.A1XA, S06.A1XD, S06.A1XS

Numerator:

The number of adult patient-months in the denominator who were on maintenance hemodialysis using a catheter continuously for three months or longer as of the last hemodialysis session of the reporting month

Numerator Instructions:

INVERSE MEASURE –see Implementation Considerations

NUMERATOR NOTE:
Vascular access type for the measure is obtained from EQRS only (representative of all ESRD dialysis patients). For a given month, patients with a catheter are defined as having one of the following access types in the table below. In addition, patients with a missing value for the access type are also considered to have a catheter. EQRS is the data source for establishing the numerator. EQRS access types recorded period is from 10/1/2025 to 12/31/2026

Table: Catheter Access Types

*Appeared beginning in July 2023.

Numerator Options:

Performance Not Met: The number of adult patient-months in the denominator who were on maintenance hemodialysis under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month using a catheter continuously for less than three months (G1027)

OR

Performance Met: The number of adult patient-months in the denominator who were on maintenance hemodialysis using a catheter continuously for three months or longer under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month (G1026)

RATIONALE

Several observational studies have demonstrated an association between type of vascular access used for hemodialysis and patient mortality1-4. Long term catheter use is associated with the highest mortality risk while arteriovenous fistula use has the lowest mortality risk. Arteriovenous grafts (AVG) have been found to have a risk of death that is higher than AVF but lower than catheters.

The measure focus is the process of assessing long term catheter use at chronic dialysis facilities.

This process leads to improvement in mortality as follows: Measure long term catheter rate → Assess value → Identify patients who do not have an AV Fistula or AV graft → Evaluation for an AV fistula or graft by a qualified dialysis vascular access provider → Increase Fistula/Graft Rate → Lower catheter rate → Lower patient mortality