Skip to content

2024 MIPS Measure #116: Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis



MIPS Clinical Quality Measures (CQMS)

‌MEASURE TYPE: Process – High Priority


The percentage of episodes for patients ages 3 months and older with a diagnosis of acute bronchitis/bronchiolitis that did not result in an antibiotic dispensing event.


This measure is to be submitted at each occurrence of acute bronchitis/bronchiolitis during the performance period. 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.

NOTE: Patient encounters for this measure conducted via telehealth (including but not limited to encounters coded with GQ, GT, 95, POS 02, POS 10) are allowable.

Measure Submission Type

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third-party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third-party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third-party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.


All patients aged 3 months or older with an outpatient visit, telephone visit, e-visit or virtual check-in, observation visit or emergency department (ED) visit with a diagnosis of acute bronchitis/bronchiolitis during the measurement period

DENOMINATOR NOTE: Do not include visits that result in an inpatient admission. When a visit and an inpatient stay are billed on separate claims, the visit results in an inpatient stay when the visit date of service occurs on the day prior to the admission date or any time during the admission (admission date through discharge date). A visit billed on the same claim as an inpatient stay is considered a visit that resulted in an inpatient stay.

*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 3 months of age and older on date of encounter


Diagnosis for acute bronchitis/bronchiolitis (ICD-10-CM): J20.3, J20.4, J20.5, J20.6, J20.7, J20.8, J20.9, J21.0, J21.1, J21.8, J21.9


Patient encounter during the performance period (CPT or HCPCS): 98966, 98967, 98968, 98970, 98971, 98972 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99238, 99239, 99242*, 99243*, 99244*, 99245*, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99381*, 99382*, 99383*, 99384*, 99385*, 99386*, 99387*, 99391*, 99392*, 99393*, 99394*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99421, 99422, 99423, 99429*, 99441, 99442, 99443, 99455, 99456, 99457, 99483, G0071, G0402, G0438, G0439, G0463*, G2010, G2012, G2250, G2251, G2252, T1015*


Place of Service (POS): 21


Denominator Exclusions:

Outpatient, ED or Observation visits that result in an inpatient admission: G2176


Acute bronchitis/bronchiolitis episodes when the patient had a new or refill prescription of antibiotics (Table 1) in the 30 days prior to the episode date: G2177


Documentation of medical reason(s) for prescribing or dispensing antibiotic (e.g., intestinal infection, pertussis, bacterial infection, Lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis/ mastoiditis/bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia, gonococcal infections/venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis/UTI, acne, HIV disease/asymptomatic HIV, cystic fibrosis, disorders of the immune system, malignancy neoplasms, chronic bronchitis, emphysema, bronchiectasis, extrinsic allergic alveolitis, chronic airway obstruction, chronic obstructive asthma, pneumoconiosis and other lung disease due to external agents, other diseases of the respiratory system, and tuberculosis): G9712


Patients who use hospice services any time during the measurement period: G9713


Patients who were not prescribed or dispensed antibiotics (Table 1) on or within 3 days of the initial date of service.

Numerator Instructions:

For performance, the measure will be calculated as the number of patient encounters where antibiotics were neither prescribed nor dispensed on or within 3 days of the episode for acute bronchitis/bronchiolitis over the total number of encounters in the denominator (patients aged 3 months and older with an outpatient, telephone, e-visit or virtual check-in, observation or ED visit for acute bronchitis/bronchiolitis). A higher score indicates appropriate treatment of patients with acute bronchitis/bronchiolitis (e.g., the proportion for whom antibiotics were not prescribed or dispensed on or three days after the encounter). Delayed prescriptions (where an antibiotic was prescribed and patient was instructed to delay taking the antibiotic) are considered “Performance Not Met”.


Table 1 – Antibiotic Medications

Note: This list should be used when assessing antibiotic prescriptions for the denominator exclusion and numerator components.





Amikacin Gentamicin

Streptomycin Tobramycin






Beta-lactamase inhibitors

Amoxicillin-clavulanate Ampicillin- sulbactam


First-generation cephalosporins

Cefadroxil Cephalexin


Fourth-generation cephalosporins


Lincomycin derivatives

Clindamycin Lincomycin


Azithromycin Clarithromycin


Miscellaneous antibiotics

Aztreonam Chloramphenicol Dalfopristin-quinupristin Daptomycin

Linezolid Metronidazole Vancomycin

Natural penicillins

Penicillin G benzathine- procaine

Penicillin G potassium Penicillin G procaine

Penicillin G sodium Penicillin V potassium Penicillin G benzathine

Penicillinase resistant penicillins

Dicloxacillin Nafcillin



Ciprofloxacin Gemifloxacin

Levofloxacin Moxifloxacin


Rifamycin derivatives


Second generation cephalosporin

Cefaclor Cefotetan Cefoxitin

Cefprozil Cefuroxime





Doxycycline Tetracycline


Third generation cephalosporins

Cefdinir Cefpodoxime Cefixim

Cefotaxime Ceftriaxone Ceftazidime

Urinary anti-infectives

Fosfomycin Nitrofurantoin

Nitrofurantoin macrocrystals- monohydrate



Numerator Options:

Performance Met: Antibiotic neither prescribed nor dispensed (4124F)


Performance Not Met: Antibiotic prescribed or dispensed (4120F)

Stay updated with the latest news regarding MACRA and MIPS

The Healthmonix Advisor is a free news source that connects you to the latest in the value-based care industry!

Ready to report like a pro?

See how