2026 #499 MIPS Measure Appropriate Screening and Plan of Care for Elevated Intraocular Pressure Following Intravitreal or Periocular Steroid Therapy

‌2026 COLLECTION TYPE:‌

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

‌MEASURE TYPE:

Process

‌DESCRIPTION:

‌Percentage of patients who had an intravitreal or periocular corticosteroid injection (e.g., triamcinolone, preservative-free triamcinolone, dexamethasone, dexamethasone intravitreal implant, or fluocinolone intravitreal implant) who, within seven‌‌ (7) weeks following the date of injection, are screened for elevated intraocular pressure (IOP) with tonometry with documented IOP ≤ 25 mm Hg for injected eye OR if the IOP was > 25 mm Hg, a plan of care was documented.

‌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 who had an intravitreal or periocular corticosteroid injection. 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-process measure is submitted a minimum of once per patient during the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.

Telehealth:

NOT TELEHEALTH ELIGIBLE: This measure is not appropriate for nor applicable to the telehealth setting. Patient encounters for this measure conducted via telehealth should be removed from the denominator eligible patient population. Therefore, if the patient meets all denominator criteria but the encounter is conducted via telehealth, it would be appropriate to remove them 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: ‌

Patients who had an intravitreal or periocular corticosteroid injection (e.g., triamcinolone, preservative-free triamcinolone, dexamethasone, dexamethasone intravitreal implant, or fluocinolone intravitreal implant) with a patient encounter during the performance period.

‌DENOMINATOR NOTE:

*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

Patient encounters during the performance period (CPT): 92002, 92004, 92012, 92014, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*

WITHOUT

Encounters conducted via telehealth: M1426

AND

Patients who had an intravitreal or periocular corticosteroid injection (e.g., triamcinolone, preservative-free triamcinolone, dexamethasone, dexamethasone intravitreal implant, or fluocinolone intravitreal implant): M1324

AND NOT

DENOMINATOR EXCLUSION:

Patients with a diagnosis of hypotony: M1326

‌NUMERATOR:

Number of patients who, within seven (7) weeks following the date of injection, are screened for elevated intraocular pressure (IOP) with tonometry with documented IOP ≤ 25 mm Hg for injected eye listed in chart OR if the IOP was > 25 mm Hg, a plan of care was documented.

‌Definition:

Plan of care – Plan of care includes one of the following: placement on IOP lowering medication (i.e., placement on a new medication, change in frequency or dose of an existing medication, or re-prescribing/renewing an existing medication), order for or performance of a IOP lowering procedure, referral to eye care provider for management of elevated IOP, or return within 4 weeks for IOP re-check.

‌Numerator Instructions:

For patients who receive more than one injection during the measurement period (12 months), screening only needs to occur once to meet the numerator. Tonometry with documented IOP should occur for the same eye that was injected.

‌NUMERATOR NOTE:

If the intravitreal or periocular corticosteroid injection occurs from November 12th – December 31st of the performance period and the patient is not able to be seen for follow-up within the performance period, it would be appropriate to report the denominator exception for inadequate time for follow-up.

‌Numerator Options:‌

‌Performance Met: Patients seen within 7 weeks following the date of injection AND are screened for elevated intraocular pressure (IOP) with tonometry with documented IOP ≤ 25 mm Hg for injected eye (M1322)

‌OR

Performance Met: Patients seen within 7 weeks following the date of injection AND are screened for elevated intraocular pressure (IOP) with tonometry with documented IOP > 25 mm Hg AND a plan of care was documented (M1323)

OR

‌Denominator Exception: Patients who were not seen for reasons documented by clinician for patient or medical reasons (e.g., inadequate time for follow-up, patients who received a prior intravitreal or periocular steroid injection within the last six (6) months and had a subsequent IOP evaluation with IOP < 25mm Hg within seven (7) weeks of treatment) (M1325)‌

OR

‌Performance Not Met: Patients who were not seen within 7 weeks following the date of injection for follow up OR who did not have a documented IOP OR no plan of care documented if the IOP was > 25 mm Hg (M1321)

RATIONALE

Patients treated with corticosteroid therapy are at increased risk for elevated IOP leading to steroid-induced glaucoma and their quality of life may be negatively impacted due to visual impairments (Breusegem, 2009; Haller, 2011; Iwao, 2007; Jonas, 2003; Phulke, 2017; Skalicky, 2012; Smithen, 2004; Vedantham, 2005).
Several randomized clinical trials and a systematic review identified that IOPs typically peak around 7-9 weeks (Haller, 2010; Kiddee, 2013; Aref, 2015). Ensuring that appropriate monitoring is conducted to detect and treat this complication is important to prevent significant visual morbidity. This measure encourages providers to screen and treat patients identified with an elevated IOP in a timely manner.