2026 #486 MIPS Measure Dermatitis – Improvement in Patient-Reported Itch Severity

2026 COLLECTION TYPE:

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

‌MEASURE TYPE: ‌Patient-Reported Outcome-based Performance Measure – High Priority

Description:

‌The percentage of patients aged 8 years and older, with a diagnosis of dermatitis where at an initial (index) visit have a patient-reported itch severity assessment performed, score greater than or equal to 4, and who achieve a score reduction of 3 or more points at a follow-up visit.

Instructions:

Reporting Frequency:
This outcome measure is to be submitted each denominator eligible visit 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 dermatitis. 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 visit measure is submitted each time a patient has a denominator eligible encounter during the performance period.

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 aged 8 years and older, with a diagnosis of dermatitis with an initial (index) visit Numeric Rating Scale (NRS), Visual Rating Scale (VRS), or ItchyQuant assessment score of greater than or equal to 4 who are returning for a follow-up visit.

Definitions:
Numeric Rating Scale (NRS) for Pruritis – The “NRS” is comprised of one item and represents the numbers 0 (“no itch”) to 10 (“worst imaginable itch”). Patients are asked to rate the intensity of their itch over the last 24 hours.
Visual Rating Scale (VRS) for Pruritis – The “VRS”, is comprised of one item and represents the numbers 0 (“no itch”) to 10 (“worst imaginable itch”). Patients are asked to rate the intensity of their itch over the last 24 hours. Note: This scale is intended for patients 18 years and older.
ItchyQuant – An illustrated numeric rating scale for itch severity and represent the numbers 0 (“no itch”) to 10 (“worst itch imaginable”). Patients are asked to rate itch severity over the past 7 days.

DENOMINATOR NOTE:
The initial (index) visit assessment and the follow-up visit for assessment must occur during the performance period. The initial (index) visit is the first encoutner with the patient during the performance period. Every visit after the initial (index) visit during the performance period is a follow-up visit. An assessment should be completed at each visit.
*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):

Patients aged ≥ 8 years on the date of the encounter

AND

Diagnosis for Atopic Dermatitis (ICD-10-CM): L20.82, L20.84, L20.89, L20.9

OR

Diagnosis of Irritant Contact Dermatitis (ICD-10-CM): L24.0, L24.1, L24.2, L24.3, L24.4, L24.5, L24.6, L24.7, L24.81, L24.89, L24.9

OR

Diagnosis of Allergic Contact Dermatitis (ICD-10-CM): L23.0, L23.1, L23.2, L23.3, L23.4, L23.5, L23.6, L23.7, L23.81, L23.89, L23.9, L25.0, L25.1, L25.2, L25.3, L25.4, L25.5, L25.8, L25.9, L56.0, L56.1, L56.2

OR

Diagnosis for Nummular Dermatitis (ICD-10-CM): L30.0

OR

Diagnosis for Other/Unspecified Dermatitis (ICD-10-CM): L30.1, L30.2, L30.3, L30.8, L30.9

AND

At least two patient encounters during the performance period (CPT): 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*

AND

Initial (index visit) Numeric Rating Scale (NRS), Visual Rating Scale (VRS), or ItchyQuant assessment score of greater than or equal to 4: M1204

‌Numerator:

Patients who achieve an assessment score that is reduced by 3 or more points (minimal clinically important difference) from the initial (index) assessment score

Numerator Instructions:

To successfully report this measure, the physician(s) and/or provider(s) of the same clinical practice must use the same assessment tool for both the initial (index) AND follow-up assessment using one of the validated tools (NRS, VRS, or ItchyQuant). Eligible clinicians who develop the care plan for the patient at the initial (index) visit will be eligible to report this measure.

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

Table 1: Initial Assessment Score Difference

Numerator Options:

Performance Met: Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score (M1205)

OR

Performance Not Met: Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter (M1206)

RATIONALE

Various types of dermatitis are chronically pruritic and are tremendously burdensome. Atopic dermatitis (AD) is a chronic skin disease in which pruritus is responsible for much of the disease burden and morbidity borne by patients (Eichenfield, 2014). It is estimated that in the U.S. alone, 31.6 million people have symptoms of AD, with 17.8 million meeting the criteria for AD. The effects of this disease are substantial; with direct costs estimated to be between $1 and $4 billion (Hanifin, 2007).
Other types of dermatitis, such as contact dermatitis and seborrheic dermatitis (SD) are also chronic, pruritic conditions which greatly affect patients. Approximately 6 million people in the U.S. have SD with direct and indirect costs estimated to be $230 million (Goldenberg, 2013).
These various forms of dermatitis also greatly impact the quality-of-life patients have. In one study looking at the patient burden in adults with moderate to severe AD, 85% reported problems with the frequency of their itch and 41.5 percent reported itching for 18 hours or more a day. With this persistence of itching, 55 percent of patients showed AD-related sleep disturbance 5 days a week or more and 21.8 percent showed clinically relevant anxiety or depression (Simpson, 2016).
In another study, investigators quantified pruritic burden in a cross-sectional analysis investigating chronic pruritus and pain. They demonstrated that the quality-of-life impact was due to the severity of the symptom, rather than whether the symptom was pain or pruritus. Moreover, they elucidated a mean health utility score of 0.87 from CP patients, meaning that on average, a patient would give up 13 percent of their life expectancy to live without pruritus (Kini, 2011). Additionally, studies of CP have shown patients to have a 17 percent higher mortality risk as well as being strongly associated with poorer general health (Ständer, 2013).
Moreover, data from the National Ambulatory Medical Care Survey (1999-2009) found that a total of 77 million patient visits for itch were made during the 11-year time period. This was an average of 7 million visits per year, which represented approximately 1 percent of all outpatient visits. Also, further analysis showed that although the majority visits (58.6 percent) were for new instances of itch, almost a third (32 percent) were for chronic pruritus (Shive, 2013).
This measure aims to improve pruritus in patients who carry a large burden with this disease; by assessing itch and aiming to make the symptom more manageable.