2026 #489 MIPS Measure Adult Kidney Disease: Angiotensin Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy

2026 COLLECTION TYPE:

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

‌MEASURE TYPE: Process

‌Description:

‌Percentage of patients aged 18 years and older with a diagnosis of chronic kidney disease (CKD) (Stages 1-5, not receiving Renal Replacement Therapy (RRT)) and proteinuria who were prescribed ACE inhibitor or ARB therapy within a 12-month period.

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 a diagnosis of CKD (Stages 1-5, not receiving Renal Replacement Therapy (RRT)) and proteinuria seen during the performance period. 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 the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient for the performance period. The most advantageous quality data code (QDC) 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 aged 18 years and older with the diagnosis of CKD (Stages 1-5, not receiving RRT) and proteinuria

Definitions:

Proteinuria:

1. > 300mg of albumin in the urine per 24 hours OR
2. Urine albumin-to-creatinine ratio (ACR) > 300 mg/g OR
3. Urine protein-to-creatinine ratio (PCR) > 0.3 g/g

Renal Replacement Therapy (RRT) – For the purposes of this measure, RRT includes hemodialysis, peritoneal dialysis, and kidney transplantation.
Patients receiving RRT – see Reference Coding

Denominator Criteria (Eligible Cases):

All patients aged 18 years and older on the date of the encounter

AND

Diagnosis of CKD (Stages 1-5) (ICD-10-CM): E11.22, N18.1, N18.2, N18.30, N18.31, N18.32, N18.4, N18.5, N18.9

AND

Diagnosis of Proteinuria (ICD-10-CM): R80.1, R80.8, R80.9

AND

Patient encounter 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, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350

AND NOT

DENOMINATOR EXCLUSION:

Patients receiving RRT: M1199

Reference Coding:

Denominator Exclusion for RRT [M1199] is defined by the following coding only: 90951, 90952, 90953, 90954, 90955, 90956, 90957, 90958, 90959, 90960, 90961, 90962, 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, I70.1, N18.6, Z49.31, Z49.32, Z99.2

‌Numerator:

Patients who were prescribed ACE inhibitor or ARB therapy within a 12-month period

Definition:
Prescribed – May include prescription given to the patient for ACE Inhibitor or ARB therapy OR patient already taking ACE Inhibitor or ARB therapy as documented in the current medication list.

Numerator Options:

Performance Met: ACE Inhibitor (ACE-I) or ARB therapy prescribed during the measurement period (M1200)

OR

Denominator Exception: Documentation of medical reason(s) for not prescribing ACE inhibitor (ACE-I) or ARB therapy during the measurement period (e.g., pregnancy, history of angioedema to ACE-I, other allergy to ACE-I and ARB, hyperkalemia or history of hyperkalemia while on ACE-I or ARB therapy, acute kidney injury due to ACE-I or ARB therapy, other medical reasons.) (M1201)

OR

Denominator Exception: Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB therapy during the measurement period (e.g., patient declined, other patient reasons) (M1202)

OR

Performance Not Met: ACE inhibitor or ARB therapy not prescribed during the measurement period, reason not given (M1203)

RATIONALE

This measure is aimed at increasing the number of patients with CKD and proteinuria who are prescribed ACE inhibitor or ARB therapy. ACE inhibitors and ARBs are preferred agents for diabetic kidney disease and nondiabetic kidney diseases with proteinuria (albuminuria), even in the absence of hypertension. In these diseases, ACE inhibitors and ARBs lower blood pressure, reduce proteinuria (albuminuria), slow the progression of kidney disease, and likely reduce cardiovascular disease risk by mechanisms in addition to lowering blood pressure. These benefits have been shown across high quality, multi-center, randomized controlled trials such as RENAAL (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan) (Brenner et al., New England Journal of Medicine, 2001). A meta-analysis of randomized trials showed that ACEi/ARB therapy lowered the odds of kidney failure (also known as end-stage renal disease [ESRD]) by 30-39 percent and of cardiovascular disease events by 18 percent-24 percent (Xie et al., Am J Kidney Dis, 2016). In a meta-analysis including primarily diabetic patients with proteinuria, use of ACEi/ARB therapy had a 0.36 to 0.78 odds of incident kidney failure (Cai et al., Nephrology, dialysis, transplantation, 2018). Similarly, in a Cochrane meta-analysis, patients with early (stage 1 to 3) non-diabetic CKD who were treated versus not treated with ACEi/ARB had 31 percent lower risk of kidney failure (Jafar et al., Annals of internal medicine, 2001). Based upon this robust evidence, ACE inhibitors and ARBs are recommended for patients with CKD and proteinuria by the Kidney Disease: Improving Global Outcomes (KDIGO) international guidelines and the Kidney Disease Outcomes Quality Initiative.

CKD is a major public health problem; a total of 37 million Americans have CKD. There is a clear performance gap in ACE inhibitor and ARB usage among patients with CKD, with only 40 percent of CKD patients receiving an ACEi/ARB in NHANES data (Murphy et al., JASN, 2019). Population health efforts to increase the use of ACEi/ARB in American Indians and Alaska Natives have been associated with a decrease in incident kidney failure related to diabetic kidney disease (Bullock et al., MMWR Morbidity and mortality weekly report, 2017). In summary, this measure is a central component of high-quality nephrology care, as ACE inhibitors and ARBs decrease the rate of kidney failure, cardiovascular outcomes, and mortality in patients with CKD and proteinuria.