2024 MIPS Quality Benchmarks

What Are Quality Measure Benchmarks? 

When clinicians or groups submit measures for the Merit-based Incentive Payment System (MIPS) quality performance category, their performance on each measure is compared against the measure's benchmark to determine how many points the measure earns. Beginning in program year 2023, a clinician or group can receive anywhere from 1 to 10 points for each MIPS measure based on this comparison as long as the data completeness standards and case minimum requirements are met. Measures without an available historical or performance period benchmark will receive 0 points, even when data completeness and case minimum requirements are met (small practices will continue to receive 3 points).

Benchmarks are specific to the collection type: Qualified Clinical Data Registry (QCDR) measures, MIPS Clinical Quality Measures (MIPS CQMs)*, eCQMs, CMS Web Interface measures, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS survey, and Part B Claims measures. In order to measure performance that is comparable across the spectrum of performance, benchmarks are established using historical data.  Historical benchmarks for the 2023 performance period for eCQMs, MIPS CQMs, QCDR measures, and Medicare Part B claims measures are based on actual performance data that were submitted for the 2021 performance period.  *MIPS CQMs are measures submitted using registry rules.

How Do Benchmarks Work for Multi-Performance Rate Measures?

Several MIPS quality measures require the collection and submission of data for multiple populations. This means that there can be multiple performance rates associated with a single measure. Historical benchmarks for multi-performance rate measures are created based on an "overall performance rate" (based on a weighted average, simple average, or CMS-specified performance rate):

How Are Benchmarks Displayed?

Each benchmark is presented in terms of deciles. Points will be awarded within each decile (see table below). The table identifies the range of points generally available for each measure, based on which decile a clinician or group's performance rate falls into. Clinicians who receive a score in the first decile will receive 1 point. Clinicians who are in the 3rd decile will receive somewhere between 3 and 3.9 points depending on their exact position in the decile, and clinicians in higher deciles will receive a corresponding number of points. For example, if a clinician submits performance data of 83% on a non-inverse measure, and the 5th decile begins at 72% and the 6th decile begins at 85%, then the clinician will receive between 5 and 5.9 points because 83% is in the 5th decile. For inverse measures where a higher performance is seen by a lower number on the performance score, the scores are reversed in the benchmark deciles (example: Measure 1). An Excel version of the 2023 MIPS Quality Historical Benchmarks can be found here

*Measures marked in blue (example: Measure 130) can only earn a maximum score of 7 points.  Topped-out means that the national median performance rate is so high that there is no meaningful difference in performance between clinicians.

M. NameM.
ID
Coll
Type
Dec
1
Dec
2
Dec
3
Dec
4
Dec
5
Dec
6
Dec
7
Dec
8
Dec
9
Dec
10
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)001MIPS CQM99.00 - 90.0190.00 - 80.0180.00 - 70.0170.00 - 60.0160.00 - 50.0150.00 - 40.0140.00 - 30.0130.00 - 20.0120.00 - 10.01<= 10.00
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)001eCQM99.50 - 93.6393.62 - 72.2272.21 - 53.1953.18 - 41.6341.62 - 34.1634.15 - 29.0629.05 - 24.2624.25 - 19.8419.83 - 14.54<= 14.53
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)001Medicare Part B Claims99.00 - 90.0190.00 - 80.0180.00 - 70.0170.00 - 60.0160.00 - 50.0150.00 - 40.0140.00 - 30.0130.00 - 20.0120.00 - 10.01<= 10.00
Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD)005MIPS CQM42.86 - 90.2790.28 - 96.5496.55 - 98.9898.99 - 99.99----100------
Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD)005eCQM--------------------
Coronary Artery Disease (CAD): Antiplatelet Therapy006MIPS CQM48.81 - 79.8279.83 - 87.3787.38 - 91.3391.34 - 94.8494.85 - 97.4397.44 - 99.99------100
Coronary Artery Disease (CAD): Beta-Blocker Therapy – Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF < 40%)007MIPS CQM61.29 - 80.5580.56 - 86.6286.63 - 89.5589.56 - 92.9792.98 - 95.7095.71 - 98.1998.20 - 99.99----100
Coronary Artery Disease (CAD): Beta-Blocker Therapy – Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF < 40%)007eCQM42.86 - 78.3278.33 - 83.8183.82 - 86.6686.67 - 88.6388.64 - 90.1990.20 - 91.6691.67 - 93.0093.01 - 94.7394.74 - 96.46>= 96.47
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)008MIPS CQM43.33 - 94.2894.29 - 97.9397.94 - 99.4199.42 - 99.99----100.00------
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)008eCQM31.18 - 82.6082.61 - 86.6686.67 - 89.1289.13 - 90.9090.91 - 92.4692.47 - 93.6893.69 - 94.9995.00 - 96.4996.50 - 98.22>= 98.23
Anti-Depressant Medication Management009eCQM10.40 - 66.9766.98 - 74.3174.32 - 77.0277.03 - 79.2579.26 - 81.2481.25 - 82.8982.90 - 84.3784.38 - 86.7686.77 - 90.62>= 90.63
Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation012eCQM4.43 - 70.5270.53 - 85.7085.71 - 90.8090.81 - 93.9994.00 - 96.2596.26 - 97.6697.67 - 98.6998.70 - 99.4399.44 - 99.99100.00
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care019MIPS CQM4.44 - 88.2988.30 - 97.8297.83 - 99.99------100.00------
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care019eCQM9.52 - 50.4250.43 - 69.4969.50 - 77.9477.95 - 83.5983.60 - 88.3588.36 - 91.3591.36 - 93.9793.98 - 96.5496.55 - 98.75>= 98.76
Communication with the Physician or Other Clinician Managing On-Going Care Post-Fracture for Men and Women Aged 50 Years and Older024MIPS CQM0.60 - 44.3444.35 - 68.1068.11 - 77.7777.78 - 84.6584.66 - 91.5991.60 - 96.9496.95 - 99.99----100.00
Communication with the Physician or Other Clinician Managing On-Going Care Post-Fracture for Men and Women Aged 50 Years and Older024Medicare Part B Claims--------------------
Screening for Osteoporosis for Women Aged 65-85 Years of Age039MIPS CQM0.25 - 6.706.71 - 21.9621.97 - 42.3042.31 - 54.6554.66 - 63.2563.26 - 71.1971.20 - 81.1981.20 - 89.6589.66 - 97.97>= 97.98
Screening for Osteoporosis for Women Aged 65-85 Years of Age039Medicare Part B Claims1.52 - 24.9925.00 - 52.2452.25 - 65.5765.58 - 73.7773.78 - 82.3482.35 - 88.5588.56 - 96.1896.19 - 99.2299.23 - 99.99100.00
Advance Care Plan047MIPS CQM0.21 - 14.7214.73 - 53.3453.35 - 76.4476.45 - 88.3788.38 - 95.4595.46 - 98.9198.92 - 99.8999.90 - 99.99--100.00
Advance Care Plan047Medicare Part B Claims------------100.00------
Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older 048MIPS CQM3.44 - 52.9352.94 - 82.6382.64 - 93.1593.16 - 98.0498.05 - 99.5899.59 - 99.99100.00------
Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older050MIPS CQM6.45 - 49.9950.00 - 73.6073.61 - 79.7979.80 - 85.0585.06 - 90.0790.08 - 97.0997.10 - 99.99----100
Chronic Obstructive Pulmonary Disease (COPD): Long-Acting Inhaled Bronchodilator Therapy052MIPS CQM--------------------
Appropriate Treatment for Upper Respiratory Infection (URI)065MIPS CQM52.69 - 88.36/td>88.37 - 92.6192.62 - 94.9194.92 - 96.1196.12 - 97.2397.24 - 98.2698.27 - 98.8998.90 - 99.4499.45 - 99.99100.00
Appropriate Treatment for Upper Respiratory Infection (URI)065eCQM26.42 - 72.3172.32 - 84.3484.35 - 88.9388.94 - 91.7391.74 - 94.2894.29 - 96.3196.32 - 97.9597.96 - 99.3199.32 - 99.99100.00
Appropriate Testing for Pharyngitis066MIPS CQM34.65 - 91.2291.23 - 94.7794.78 - 96.9396.94 - 98.1798.18 - 99.3299.33 - 99.8999.90 - 100.00------
Appropriate Testing for Pharyngitis066eCQM1.05 - 9.9910.00 - 29.1629.17 - 46.1346.14 - 60.6060.61 - 69.3769.38 - 77.4177.42 - 83.4283.43 - 87.8487.85 - 91.13>= 91.14
Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients102MIPS CQM--------------------
Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients102eCQM--------------------
Prostate Cancer: Combination Androgen Deprivation Therapy for High Risk or Very High Risk Prostate Cancer 104MIPS CQM--------------------
Breast Cancer Screening112MIPS CQM0.43 - 29.7329.74 - 49.3849.39 - 58.0858.09 - 67.0867.09 - 75.1575.16 - 79.6079.61 - 86.3586.36 - 94.0594.06 - 99.99100.00
Breast Cancer Screening112eCQM0.20 - 8.288.29 - 28.4528.46 - 42.7542.76 - 52.4152.42 - 59.7859.79 - 65.6365.64 - 71.4271.43 - 77.1177.12 - 84.55>= 84.56
Breast Cancer Screening112Medicare Part B Claims2.25 - 34.0334.04 - 67.9167.92 - 75.8575.86 - 84.0984.10 - 92.1892.19 - 95.8795.88 - 98.6598.66 - 99.99--100.00
Colorectal Cancer Screening113MIPS CQM1.16 - 31.7731.78 - 51.5751.58 - 62.5562.56 - 70.3070.31 - 77.0177.02 - 84.1884.19 - 88.3188.32 - 94.5994.60 - 99.54>= 99.55
Colorectal Cancer Screening113eCQM--------------------
Colorectal Cancer Screening113Medicare Part B Claims------------100.00------
Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis116MIPS CQM36.11 - 76.3176.32 - 86.0486.05 - 89.2489.25 - 92.6992.70 - 94.2594.26 - 95.8895.89 - 97.6397.64 - 98.6098.61 - 99.99100.00
Diabetes: Eye Exam117MIPS CQM10.26 - 79.9980.00 - 96.4596.46 - 99.2099.21 - 99.99----100.00------
Diabetes: Eye Exam117eCQM0.50 - 6.326.33 - 16.1416.15 - 27.2427.25 - 41.0841.09 - 65.6665.67 - 93.5693.57 - 98.4598.46 - 99.6599.66 - 99.99100.00
Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy - Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%)118MIPS CQM37.29 - 73.7373.74 - 78.1478.15 - 81.9681.97 - 85.2285.23 - 88.0988.10 - 91.5791.58 - 97.7797.78 - 99.99--100.00
Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy – Neurological Evaluation126MIPS CQM0.81 - 27.9127.92 - 66.3666.37 - 88.7688.77 - 98.3098.31 - 99.99--100.00------
Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention – Evaluation of Footwear127MIPS CQM0.95 - 54.0654.07 - 87.6987.70 - 97.9197.92 - 99.99----100.00------
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan128MIPS CQM1.20 - 39.8239.83 - 75.0975.10 - 91.8891.89 - 98.3198.32 - 99.7599.76 - 99.99100.00------
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan128eCQM4.31 - 18.1118.12 - 22.0822.09 - 25.6125.62 - 29.9429.95 - 36.8336.84 - 51.4251.43 - 73.2173.22 - 87.4187.42 - 96.48>= 96.49
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan128Medicare Part B Claims14.94 - 67.5067.51 - 94.8594.86 - 99.0899.09 - 99.8799.88 - 99.99--100.00------
Documentation of Current Medications in the Medical Record130MIPS CQM3.80 - 68.1268.13 - 92.9993.00 - 98.2298.23 - 99.6499.65 - 99.9499.95 - 99.99100.00------
Documentation of Current Medications in the Medical Record130eCQM5.12 - 61.3761.38 - 80.2480.25 - 87.9087.91 - 92.2392.24 - 95.2095.21 - 97.0797.08 - >= 99.88------
Preventive Care and Screening: Screening for Depression and Follow-Up Plan134MIPS CQM0.05 - 61.7661.77 - 89.4589.46 - 97.2497.25 - 99.2199.22 - 99.9699.97 - 99.99100:00------
Preventive Care and Screening: Screening for Depression and Follow-Up Plan134eCQM--------------------
Preventive Care and Screening: Screening for Depression and Follow-Up Plan134Medicare Part B Claims2.38 - 90.2790.28 - 99.4399.44 - 99.99------100.00------
Melanoma: Continuity of Care – Recall System137MIPS CQM9.58 - 95.5495.55 - 99.99--------------100.00
Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% OR Documentation of a Plan of Care141MIPS CQM10.13 - 86.0586.06 - 94.4294.43 - 97.3897.39 - 98.9498.95 - 99.5399.54 - 99.8699.87 - 99.99----100.00
Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% OR Documentation of a Plan of Care141Medicare Part B Claims------------------100.00
Oncology: Oncology: Medical and Radiation – Pain Intensity Quantified143MIPS CQM1.60 - 81.7281.73 - 97.0597.06 - 99.5399.54 - 99.99----100.00------
Oncology: Medical and Radiation - Pain Intensity Quantified143eCQM2.12 - 24.0424.05 - 77.9477.95 - 90.6490.65 - 94.6294.63 - 96.7196.72 - 98.0598.06 - 100.00------
Oncology: Medical and Radiation – Plan of Care for Pain 144MIPS CQM7.89 - 56.6756.68 - 83.7783.78 - 90.5190.52 - 94.5894.59 - 97.0897.09 - 98.9098.91 - 99.7999.80 - 99.99--100.00
Radiology: Exposure Dose Indices or Exposure Time and Number of Images Reported for Procedures Using Fluoroscopy145MIPS CQM--------------------
Radiology: Exposure Dose Indices or Exposure Time and Number of Images Reported for Procedures Using Fluoroscopy145Medicare Part B Claims--------------------
Falls: Plan of Care155MIPS CQM18.29 - 93.0593.06 - 99.8199.82 - 99.99------100.00------
Falls: Plan of Care155Medicare Part B Claims------------100.00------
Coronary Artery Bypass Graft (CABG): Prolonged Intubation164MIPS CQM--------------------
Coronary Artery Bypass Graft (CABG): Postoperative Renal Failure167MIPS CQM--------------------
Coronary Artery Bypass Graft (CABG): Surgical Re-Exploration168MIPS CQM--------------------
Tuberculosis Screening Prior to First Course Biologic Therapy176MIPS CQM18.63 - 67.3867.39 - 81.8181.82 - 91.2291.23 - 98.3598.36 - 99.99--100.00------
Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity177MIPS CQM6.62 - 64.8064.81 - 77.9377.94 - 86.7086.71 - 92.0892.09 - 97.8997.90 - 99.6199.62 - 100.00------
Rheumatoid Arthritis (RA): Functional Status Assessment178MIPS CQM5.00 - 75.1275.13 - 91.1491.15 - 94.8594.86 - 98.4098.41 - 99.7699.77 - 99.99100.00------
Rheumatoid Arthritis (RA): Glucocorticoid Management180MIPS CQM54.05 - 68.6968.70 - 78.0778.08 - 87.8787.88 - 95.7595.76 - 99.3299.33 - 99.7499.75 - 100.00------
Elder Maltreatment Screen and Follow-Up Plan181MIPS CQM55.00 - 98.4898.49 - 99.8499.85 - 99.99------100.00------
Elder Maltreatment Screen and Follow-Up Plan181Medicare Part B Claims0.44 - 96.7496.75 - 99.99--------100.00------
Functional Outcome Assessment182MIPS CQM0.10 - 98.9098.91 - 99.8499.85 - 99.99------100.00------
Colonoscopy Interval for Patients with a History of Adenomatous Polyps – Avoidance of Inappropriate Use 185MIPS CQM12.91 - 86.4986.50 - 96.8096.81 - 99.5199.52 - 99.99----100.00------
Stroke and Stroke Rehabilitation: Thrombolytic Therapy187MIPS CQM42.86 - 90.5590.56 - 94.4194.42 - 97.9197.92 - 99.99----100.00------
Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery191MIPS CQM51.85 - 93.7493.75 - 97.0497.05 - 98.5398.54 - 99.2799.28 - 99.99--------100.00
Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery191eCQM28.70 - 82.2882.29 - 91.0691.07 - 94.6694.67 - 96.4296.43 - 97.4997.50 - 98.3098.31 - 98.9298.93 - 99.5199.52 - 99.99100.00
HIV/AIDS: Sexually Transmitted Disease Screening for Chlamydia, Gonorrhea, and Syphilis205MIPS CQM--------------------
HIV/AIDS: Sexually Transmitted Disease Screening for Chlamydia, Gonorrhea, and Syphilis205eCQM--------------------
Functional Status Change for Patients with Knee Impairments217MIPS CQM29.27 - 42.4142.42 - 52.3752.38 - 56.9356.94 - 63.3763.38 - 72.9372.94 - 79.9980.00 - 90.2390.24 - 99.99--100.00
Functional Status Change for Patients with Hip Impairments218MIPS CQM26.98 - 37.7737.78 - 47.6147.62 - 54.1654.17 - 61.8961.90 - 68.2868.29 - 73.7173.72 - 84.7984.80 - 99.99--100.00
Functional Status Change for Patients with Lower Leg, Foot or Ankle Impairments219MIPS CQM25.00 - 38.2338.24 - 48.7148.72 - 53.7453.75 - 63.6363.64 - 69.6169.62 - 74.4374.44 - 83.7583.76 - 97.4397.44 - 99.99100.00
Functional Status Change for Patients with Low Back Impairments220MIPS CQM29.71 - 45.9745.98 - 53.0153.02 - 58.1758.18 - 67.9667.97 - 75.2975.30 - 81.3581.36 - 93.5493.55 - 99.99--100.00
Functional Status Change for Patients with Shoulder Impairments221MIPS CQM27.59 - 42.2142.22 - 48.9748.98 - 58.1758.18 - 62.7562.76 - 71.1071.11 - 76.2476.25 - 92.5892.59 - 99.99--100.00
Functional Status Change for Patients with Elbow, Wrist or Hand Impairments222MIPS CQM23.81 - 49.9950.00 - 57.1357.14 - 61.5361.54 - 67.8567.86 - 74.9274.93 - 78.7078.71 - 82.7582.76 - 94.4394.44 - 99.99100.00
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention226MIPS CQM3.39 - 18.9118.92 - 39.1239.13 - 61.5361.54 - 78.5978.60 - 89.2889.29 - 97.0997.10 - 99.99----100.00
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention226eCQM2.22 - 14.2814.29 - 24.9925.00 - 36.5836.59 - 49.7749.78 - 61.5361.54 - 74.4174.42 - 85.7085.71 - 94.0294.03 - 99.99100.00
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention226Medicare Part B Claims14.29 - 78.1678.17 - 95.9395.94 - 99.99------100.00------
Controlling High Blood Pressure236MIPS CQM1.00 - 9.9910.00 - 19.9920.00 - 29.9930.00 - 39.9940.00 - 49.9950.00 - 59.9960.00 - 69.9970.00 - 79.9980.00 - 89.99>= 90.00
Controlling High Blood Pressure236eCQM--------------------
Controlling High Blood Pressure236Medicare Part B Claims1.00 - 9.9910.00 - 19.9920.00 - 29.9930.00 - 39.9940.00 - 49.9950.00 - 59.9960.00 - 69.9970.00 - 79.9980.00 - 89.99>= 90.00
Use of High-Risk Medications in Older Adults238MIPS CQM--------------------
Use of High-Risk Medications in Older Adults238eCQM--------------------
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents239eCQM--------------------
Childhood Immunization Status240eCQM1.00 - 4.754.76 - 7.837.84 - 12.1512.16 - 16.6616.67 - 22.6022.61 - 28.1628.17 - 35.4735.48 - 42.1742.18 - 49.99>= 50.00
Cardiac Rehabilitation Patient Referral from an Outpatient Setting 243MIPS CQM1.99 - 24.4324.44 - 26.4626.47 - 29.2929.30 - 33.9533.96 - 39.3439.35 - 52.4952.50 - 64.6564.66 - 86.3586.36 - 96.96>= 96.97
Barrett’s Esophagus249MIPS CQM97.02 - 99.99----------100.00------
Barrett's Esophagus249Medicare Part B Claims------------100.00------
Radical Prostatectomy Pathology Reporting250MIPS CQM97.86 - 99.99----------100.00------
Radical Prostatectomy Pathology Reporting250Medicare Part B Claims------------100.00------
Ultrasound Determination of Pregnancy Location for Pregnant Patients with Abdominal Pain254MIPS CQM15.79 - 88.3188.32 - 93.3193.32 - 95.7095.71 - 97.7297.73 - 98.2398.24 - 98.9098.91 - 100.00------
Rate of Endovascular Aneurysm Repair (EVAR) of Small or Moderate Non-Ruptured Infrarenal Abdominal Aortic Aneurysms (AAA) without Major Complications (Discharged to Home by Post-Operative Day #2)259MIPS CQM--------------------
Rate of Carotid Endarterectomy (CEA) for Asymptomatic Patients, without Major Complications (Discharged to Home by Post-Operative Day #2)260MIPS CQM--------------------
Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness 261MIPS CQM--------------------
Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness261Medicare Part B Claims--------------------
Sentinel Lymph Node Biopsy for Invasive Breast Cancer264MIPS CQM--------------------
Epilepsy: Counseling for Women of Childbearing Potential with Epilepsy268MIPS CQM7.27 - 42.0642.07 - 69.2269.23 - 95.8295.83 - 99.99----------100.00
Inflammatory Bowel Disease (IBD): Assessment of Hepatitis B Virus (HBV) Status Before Initiating Anti-TNF (Tumor Necrosis Factor) Therapy275MIPS CQM--------------------
Sleep Apnea: Severity Assessment at Initial Diagnosis277MIPS CQM--------------------
Sleep Apnea: Assessment of Adherence to Positive Airway Pressure Therapy279MIPS CQM8.00 - 78.5078.51 - 91.3591.36 - 99.7999.80 - 99.99----100.00------
Dementia: Cognitive Assessment281eCQM--------------------
Dementia: Functional Status Assessment282MIPS CQM38.71 - 94.7394.74 - 99.99--------100.00------
Dementia: Safety Concern Screening and Follow-Up for Patients with Dementia286MIPS CQM50.00 - 99.5599.56 - 99.99--------100.00------
Dementia: Education and Support of Caregivers for Patients with Dementia288MIPS CQM0.82 - 78.3278.33 - 94.3394.34 - 99.99------100.00------
Assessment of Mood Disorders and Psychosis for Patients with Parkinson’s Disease290MIPS CQM13.79 - 70.3670.37 - 90.7090.71 - 97.4997.50 - 99.99----100.00------
Assessment of Cognitive Impairment or Dysfunction for Patients with Parkinson’s Disease291MIPS CQM7.55 - 40.2340.24 - 82.5982.60 - 96.6696.67 - 99.99----100.00------
Rehabilitative Therapy Referral for Patients with Parkinson’s Disease293MIPS CQM4.43 - 56.8156.82 - 92.9192.92 - 97.6197.62 - 99.99----------100.00
Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery303MIPS CQM--------------------
Cataracts: Patient Satisfaction within 90 Days Following Cataract Surgery304MIPS CQM--------------------
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment305eCQM0.31 - 1.311.32 - 2.032.04 - 2.492.50 - 3.083.09 - 3.573.58 - 4.364.37 - 5.315.32 - 6.696.70 - 9.99>= 10.00
Cervical Cancer Screening309eCQM0.34 - 7.887.89 - 16.3416.35 - 23.7723.78 - 30.9430.95 - 37.2337.24 - 43.8543.86 - 50.3050.31 - 57.8257.83 - 68.89>= 68.90
Chlamydia Screening for Women310eCQM0.84 - 7.687.69 - 12.4912.50 - 18.7418.75 - 24.9925.00 - 30.7030.71 - 36.8936.90 - 43.4743.48 - 49.9950.00 - 60.23>= 60.24
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented317MIPS CQM0.11 - 7.067.07 - 18.2018.21 - 27.7527.76 - 48.0448.05 - 81.6381.64 - 93.8593.86 - 98.9298.93 - 99.9299.93 - 99.99100.00
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented317eCQM0.06 - 4.414.42 - 12.4612.47 - 17.0517.06 - 19.9419.95 - 22.7922.80 - 25.6925.70 - 28.7828.79 - 33.1033.11 - 40.79>= 40.80
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented317Medicare Part B Claims0.17 - 23.2023.21 - 79.0479.05 - 95.6695.67 - 99.0899.09 - 99.7799.78 - 99.99100.00------
Falls: Screening for Future Fall Risk318eCQM0.14 - 5.145.15 - 22.6922.70 - 42.1442.15 - 58.3258.33 - 73.0773.08 - 84.1784.18 - 91.8291.83 - 97.0297.03 - 99.29>= 99.30
Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients 320MIPS CQM13.45 - 87.9287.93 - 91.6691.67 - 95.5995.60 - 97.2397.24 - 98.3298.33 - 99.99100.00------
Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients320Medicare Part B Claims------------100.00------
Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Preoperative Evaluation in Low-Risk Surgery Patients322MIPS CQM99.77 - 0.01----------------0.00
Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy (Suppressed) 326MIPS CQM--------------------
Adult Sinusitis: Antibiotic Prescribed for Acute Viral Sinusitis (Overuse) 331MIPS CQM94.23 - 72.7472.73 - 53.5853.57 - 32.4432.43 - 17.2517.24 - 8.288.27 - 2.572.56 - 0.01----0.00
Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin With or Without Clavulanate Prescribed for Patients with Acute Bacterial Sinusitis (Appropriate Use)332MIPS CQM12.50 - 64.4364.44 - 81.0781.08 - 88.3488.35 - 92.5892.59 - 95.4495.45 - 97.5597.56 - 99.99----100.00
Maternity Care: Elective Delivery (Without Medical Indication) at < 39 Weeks (Overuse)335MIPS CQM--------------------
Maternity Care: Postpartum Follow-Up and Care Coordination336MIPS CQM--------------------
HIV Viral Load Suppression338MIPS CQM11.81 - 68.2668.27 - 86.7786.78 - 91.3791.38 - 94.2394.24 - 95.8495.85 - 99.99------100.00
HIV Viral Load Suppression338eCQM--------------------
HIV Medical Visit Frequency 340MIPS CQM32.07 - 58.6458.65 - 72.6572.66 - 79.7779.78 - 85.0585.06 - 86.3586.36 - 89.1889.19 - 92.9192.92 - 99.99--100.00
Rate of Carotid Artery Stenting (CAS) for Asymptomatic Patients, Without Major Complications (Discharged to Home by Post-Operative Day #2) 344MIPS CQM--------------------
Total Knee or Hip Replacement: Shared Decision-Making: Trial of Conservative (Non-surgical) Therapy350MIPS CQM26.18 - 98.4198.42 - 99.9099.91 - 99.99------------100.00
Total Knee or Hip Replacement: Venous Thromboembolic and Cardiovascular Risk Evaluation351MIPS CQM47.98 - 91.9591.96 - 99.0399.04 - 99.99------------100.00
Anastomotic Leak Intervention354MIPS CQM23.33 - 6.386.37 - 4.003.99 - 2.632.62 - 1.291.28 - 0.180.17 - 0.01------0.00
Unplanned Reoperation within the 30 Day Postoperative Period355MIPS CQM35.82 - 1.811.80 - 0.820.81 - 0.01------------0.00
Unplanned Hospital Readmission within 30 Days of Principal Procedure356MIPS CQM45.37 - 5.235.22 - 3.033.02 - 1.191.18 - 0.01----------0.00
Surgical Site Infection (SSI)357MIPS CQM12.31 - 1.501.49 - 0.240.23 - 0.01------------0.00
Patient-Centered Surgical Risk Assessment and Communication358MIPS CQM0.62 - 20.9520.96 - 90.5990.60 - 98.9098.91 - 99.99----100.00------
Optimizing Patient Exposure to Ionizing Radiation: Count of Potential High Dose Radiation Imaging Studies: Computed Tomography (CT) and Cardiac Nuclear Medicine Studies 360MIPS CQM0.07 - 73.2573.26 - 82.5982.60 - 99.5799.58 - 99.99----100.00------
Optimizing Patient Exposure to Ionizing Radiation: Appropriateness: Follow-up CT Imaging for Incidentally Detected Pulmonary Nodules According to Recommended Guidelines 364MIPS CQM1.75 - 36.3536.36 - 63.3163.32 - 98.0698.07 - 99.99----100.00------
Follow-Up Care for Children Prescribed ADHD Medication (ADD)366eCQM--------------------
Depression Remission at Twelve Months370MIPS CQM--------------------
Depression Remission at Twelve Months370eCQM0.48 - 2.072.08 - 3.493.50 - 4.954.96 - 6.926.93 - 8.948.95 - 10.8810.89 - 13.9914.00 - 18.1518.16 - 24.99>= 25.00
Closing the Referral Loop: Receipt of Specialist Report374MIPS CQM--------------------
Closing the Referral Loop: Receipt of Specialist Report374eCQM0.73 - 8.328.33 - 18.6018.61 - 27.3727.38 - 35.1635.17 - 43.0143.02 - 51.2951.30 - 60.1860.19 - 72.0872.09 - 89.28>= 89.29
Functional Status Assessment for Total Hip Replacement376eCQM0.51 - 1.291.30 - 2.442.45 - 7.067.07 - 9.919.92 - 11.6711.68 - 14.1114.12 - 18.3718.38 - 25.3625.37 - 43.08>= 43.09
Functional Status Assessments for Heart Failure377eCQM--------------------
Children Who Have Dental Decay or Cavities378eCQM79.07 - 66.0766.06 - 48.6448.63 - 45.1045.09 - 34.3434.33 - 29.0229.01 - 9.209.19 - 3.653.64 - 0.910.90 - 0.010.00
Primary Caries Prevention Intervention as Offered by Primary Care Providers, including Dentists379eCQM0.01 - 0.040.05 - 0.230.24 - 0.480.49 - 0.991.00 - 1.721.73 - 3.113.12 - 4.574.58 - 6.936.94 - 11.02>= 11.03
Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment382eCQM0.46 - 2.262.27 - 5.805.81 - 13.5213.53 - 20.6120.62 - 34.8734.88 - 46.9346.94 - 59.6759.68 - 67.9467.95 - 88.08>= 88.09
Adherence to Antipsychotic Medications For Individuals with Schizophrenia383MIPS CQM6.25 - 93.7493.75 - 94.3394.34 - 99.3399.34 - 99.99----------100.00
Adult Primary Rhegmatogenous Retinal Detachment Surgery: No Return to the Operating Room Within 90 Days of Surgery384MIPS CQM67.57 - 79.1679.17 - 83.9984.00 - 90.4790.48 - 95.8295.83 - 97.6197.62 - 99.3499.35 - 100.00------
Adult Primary Rhegmatogenous Retinal Detachment Surgery: Visual Acuity Improvement Within 90 Days of Surgery385MIPS CQM10.87 - 22.3022.31 - 34.5434.55 - 53.2653.27 - 56.6256.63 - 58.9458.95 - 62.6762.68 - 65.1965.20 - 70.2070.21 - 74.99>= 75.00
Amyotrophic Lateral Sclerosis (ALS) Patient Care Preferences386MIPS CQM--------------------
Annual Hepatitis C Virus (HCV) Screening for Patients who are Active Injection Drug Users 387MIPS CQM--------------------
Cataract Surgery: Difference Between Planned and Final Refraction 389MIPS CQM0.32 - 18.3118.32 - 41.0341.04 - 51.2451.25 - 66.7966.80 - 89.4989.50 - 96.3396.34 - 99.0099.01 - 99.99--100.00
Cardiac Tamponade and/or Pericardiocentesis Following Atrial Fibrillation Ablation392MIPS CQM--------------------
Infection within 180 Days of Cardiac Implantable Electronic Device (CIED) Implantation, Replacement, or Revision393MIPS CQM--------------------
Immunizations for Adolescents394MIPS CQM1.06 - 10.9510.96 - 15.7815.79 - 19.9920.00 - 23.0723.08 - 26.6626.67 - 30.5530.56 - 33.5433.55 - 39.9940.00 - 53.84>= 53.85
Lung Cancer Reporting (Biopsy/Cytology Specimens) 395MIPS CQM87.50 - 99.99----------100.00------
Lung Cancer Reporting (Biopsy/Cytology Specimens)395Medicare Part B Claims88.37 - 99.99----------100.00------
Lung Cancer Reporting (Resection Specimens)396MIPS CQM------------100.00------
Lung Cancer Reporting (Resection Specimens)396Medicare Part B Claims--------------------
Melanoma Reporting397MIPS CQM36.71 - 97.8197.82 - 99.99--------100.00------
Melanoma Reporting397Medicare Part B Claims92.94 - 99.99----------100.00------
Optimal Asthma Control 398MIPS CQM0.15 - 3.333.34 - 4.374.38 - 29.9029.91 - 56.1256.13 - 76.0076.01 - 95.0195.02 - 98.8198.82 - 99.99--100.00
One-Time Screening for Hepatitis C Virus (HCV) for all Patients 400MIPS CQM--------------------
Hepatitis C: Screening for Hepatocellular Carcinoma (HCC) in Patients with Cirrhosis401MIPS CQM--------------------
Anesthesiology Smoking Abstinence404MIPS CQM7.70 - 41.3741.38 - 59.2459.25 - 66.6666.67 - 73.1773.18 - 77.2677.27 - 80.1580.16 - 85.4785.48 - 91.2691.27 - 96.44>= 96.45
Appropriate Follow-up Imaging for Incidental Abdominal Lesions405MIPS CQM0.96 - 8.718.72 - 31.9631.97 - 98.3798.38 - 99.99----100.00------
Appropriate Follow-up Imaging for Incidental Abdominal Lesions405Medicare Part B Claims0.47 - 4.074.08 - 6.666.67 - 16.9116.92 - 26.9126.92 - 57.1357.14 - 76.7076.71 - 97.0097.01 - 99.99--100.00
Appropriate Follow-up Imaging for Incidental Thyroid Nodules in Patients406MIPS CQM60.00 - 12.5112.50 - 2.282.27 - 0.01------0.00------
Appropriate Follow-up Imaging for Incidental Thyroid Nodules in Patients406Medicare Part B Claims40.00 - 14.3014.29 - 3.713.70 - 0.01------------0.00
Clinical Outcome Post Endovascular Stroke Treatment409MIPS CQM--------------------
Psoriasis: Clinical Response to Systemic Medications410MIPS CQM11.11 - 55.0555.06 - 79.0279.03 - 91.5291.53 - 97.5597.56 - 99.99--------100.00
Door to Puncture Time for Endovascular Stroke Treatment413MIPS CQM--------------------
Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients Aged 18 Years and Older 415MIPS CQM80.56 - 93.7493.75 - 96.1096.11 - 96.9096.91 - 98.1198.12 - 99.3699.37 - 99.99100.00------
Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients Aged 2 Through 17 Years416MIPS CQM37.50 - 18.0418.03 - 9.539.52 - 7.707.69 - 4.184.17 - 2.812.80 - 0.01------0.00
Osteoporosis Management in Women Who Had a Fracture418MIPS CQM1.04 - 5.445.45 - 9.089.09 - 12.0212.03 - 14.9414.95 - 15.9916.00 - 18.1718.18 - 22.6322.64 - 32.1332.14 - 58.32>= 58.33
Osteoporosis Management in Women Who Had a Fracture418Medicare Part B Claims--------------------
Overuse of Imaging for the Evaluation of Primary Headache419MIPS CQM26.47 - 2.942.93 - 0.770.76 - 0.01------0.00------
Varicose Vein Treatment with Saphenous Ablation: Outcome Survey420MIPS CQM--------------------
Appropriate Assessment of Retrievable Inferior Vena Cava (IVC) Filters for Removal421MIPS CQM--------------------
Performing Cystoscopy at the Time of Hysterectomy for Pelvic Organ Prolapse to Detect Lower Urinary Tract Injury422MIPS CQM--------------------
Performing Cystoscopy at the Time of Hysterectomy for Pelvic Organ Prolapse to Detect Lower Urinary Tract Injury422Medicare Part B Claims--------------------
Perioperative Temperature Management424MIPS CQM84.46 - 98.4098.41 - 99.4599.46 - 99.8899.89 - 99.9699.97 - 99.9899.99 - 99.99100.00------
Prevention of Post-Operative Nausea and Vomiting (PONV) – Combination Therapy430MIPS CQM83.13 - 96.1296.13 - 99.1499.15 - 99.7399.74 - 99.8899.89 - 99.9599.96 - 99.99100.00------
Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling431MIPS CQM--------------------
Proportion of Patients Sustaining a Bladder Injury at the Time of any Pelvic Organ Prolapse Repair432MIPS CQM--------------------
Proportion of Patients Sustaining a Bowel Injury at the time of any Pelvic Organ Prolapse Repair433MIPS CQM--------------------
Radiation Consideration for Adult CT: Utilization of Dose Lowering Techniques436MIPS CQM38.16 - 96.3996.40 - 99.9099.91 - 99.99------100.00------
Radiation Consideration for Adult CT: Utilization of Dose Lowering Techniques436Medicare Part B Claims0.46 - 82.9682.97 - 96.5196.52 - 98.8998.90 - 99.5899.59 - 99.99--100.00------
Statin Therapy for the Prevention and Treatment of Cardiovascular Disease438MIPS CQM--------------------
Statin Therapy for the Prevention and Treatment of Cardiovascular Disease438eCQM--------------------
Age Appropriate Screening Colonoscopy 439MIPS CQM3.03 - 0.100.09 - 0.01--------------0.00
Skin Cancer: Biopsy Reporting Time – Pathologist to Clinician440MIPS CQM70.53 - 97.1597.16 - 98.5698.57 - 99.4399.44 - 99.9499.95 - 99.99--100.00------
Ischemic Vascular Disease (IVD) All or None Outcome Measure (Optimal Control)441MIPS CQM2.79 - 18.3318.34 - 29.5829.59 - 34.6134.62 - 39.9539.96 - 43.1143.12 - 47.4047.41 - 52.8452.85 - 58.5758.58 - 69.44>= 69.45
Non-Recommended Cervical Cancer Screening in Adolescent Females443MIPS CQM--------------------
Risk-Adjusted Operative Mortality for Coronary Artery Bypass Graft (CABG)445MIPS CQM--------------------
Appropriate Workup Prior to Endometrial Ablation 448MIPS CQM--------------------
Appropriate Treatment for Patients with Stage I (T1c) – III HER2 Positive Breast Cancer450MIPS CQM43.33 - 68.4168.42 - 74.9975.00 - 80.8680.87 - 84.3784.38 - 86.8186.82 - 89.9990.00 - 92.5892.59 - 94.1194.12 - 99.99100.00
RAS (KRAS and NRAS) Gene Mutation Testing Performed for Patients with Metastatic Colorectal Cancer who receive Anti-epidermal Growth Factor Receptor (EGFR) Monoclonal Antibody Therapy451MIPS CQM--------------------
Patients with Metastatic Colorectal Cancer and RAS (KRAS or NRAS) Gene Mutation Spared Treatment with Anti-epidermal Growth Factor Receptor (EGFR) Monoclonal Antibodies452MIPS CQM--------------------
Percentage of Patients Who Died from Cancer Receiving Chemotherapy in the Last 14 Days of Life (lower score – better)453MIPS CQM31.82 - 20.8420.83 - 16.0116.00 - 13.5413.53 - 11.2811.27 - 9.379.36 - 7.967.95 - 6.266.25 - 4.564.55 - 2.97<= 2.96
Percentage of Patients Who Died from Cancer Admitted to Hospice for Less than 3 days (lower score – better)457MIPS CQM77.78 - 22.5922.58 - 19.4919.48 - 13.6613.65 - 11.7511.74 - 8.918.90 - 5.685.67 - 3.573.56 - 1.971.96 - 0.010.00
Back Pain After Lumbar Discectomy/Laminectomy459MIPS CQM--------------------
Leg Pain After Lumbar Discectomy/Laminectomy461MIPS CQM--------------------
Bone Density Evaluation for Patients with Prostate Cancer and Receiving Androgen Deprivation Therapy462eCQM--------------------
Prevention of Post-Operative Vomiting (POV) – Combination Therapy (Pediatrics)463MIPS CQM58.11 - 97.7297.73 - 99.6099.61 - 99.8699.87 - 99.99----100.00------
Otitis Media with Effusion: Systemic Antimicrobials - Avoidance of Inappropriate Use464MIPS CQM30.77 - 77.6077.61 - 85.2285.23 - 90.6990.70 - 92.8592.86 - 94.7794.78 - 96.2996.30 - 97.4597.46 - 99.99--100.00
Uterine Artery Embolization Technique: Documentation of Angiographic Endpoints and Interrogation of Ovarian Arteries465MIPS CQM--------------------
Continuity of Pharmacotherapy for Opioid Use Disorder (OUD)468MIPS CQM--------------------
Functional Status After Primary Total Knee Replacement470MIPS CQM--------------------
Functional Status After Lumbar Discectomy/Laminectomy471MIPS CQM--------------------
Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture472eCQM11.48 - 4.094.08 - 1.971.96 - 0.01------0.00------
HIV Screening475eCQM0.13 - 4.584.59 - 8.638.64 - 12.3112.32 - 15.3215.33 - 18.2518.26 - 21.8621.87 - 26.1726.18 - 32.0832.09 - 41.80>= 41.81
Urinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic Hyperplasia476eCQM--------------------
Multimodal Pain Management477MIPS CQM43.18 - 85.1885.19 - 93.8693.87 - 96.6896.69 - 98.2498.25 - 99.2499.25 - 99.7799.78 - 100.00------
Functional Status Change for Patients with Neck Impairments478MIPS CQM22.58 - 34.8634.87 - 48.8048.81 - 56.0056.01 - 58.2658.27 - 62.7562.76 - 69.2169.22 - 73.8673.87 - 87.8487.85 - 99.99100.00
Intravesical Bacillus-Calmette Guerin for Non-muscle Invasive Bladder Cancer481eCQM--------------------
Hemodialysis Vascular Access: Practitioner Level Long-term Catheter Rate482MIPS CQM--------------------
Person-Centered Primary Care Measure Patient Reported Outcome Performance Measure (PCPCM PRO-PM)483MIPS CQM--------------------
Psoriasis- Improvement in Patient-Reported Itch Severity485MIPS CQM--------------------
Dermatitis – Improvement in Patient-Reported Itch Severity486MIPS CQM--------------------
Screening for Social Drivers of Health487MIPS CQM--------------------
Kidney Health Evaluation488MIPS CQM--------------------
Kidney Health Evaluation488eCQM--------------------
Adult Kidney Disease: Angiotensin Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy489MIPS CQM--------------------
Appropriate Intervention of Immune-Related Diarrhea and/or Colitis in Patients Treated with Immune Checkpoint Inhibitors490MIPS CQM--------------------
Mismatch Repair (MMR) or Microsatellite Instability (MSI) Biomarker Testing Status in Colorectal Carcinoma, Endometrial, Gastroesophageal, or Small Bowel Carcinoma491MIPS CQM--------------------
Adult Immunization Status493MIPS CQM--------------------
Ambulatory Palliative Care Patients’ Experience of Feeling Heard and Understood495MIPS CQM--------------------
Cardiovascular Disease (CVD) Risk Assessment Measure - Proportion of Pregnant/Postpartum Patients that Receive CVD Risk Assessment with a Standardized Instrument496MIPS CQM--------------------
Preventive Care and Wellness (composite)497MIPS CQM--------------------
Connection to Community Service Provider498MIPS CQM--------------------
Appropriate screening and plan of care for elevated intraocular pressure following intravitreal or periocular steroid therapy499MIPS CQM--------------------
Acute posterior vitreous detachment appropriate examination and follow-up500MIPS CQM--------------------
Acute posterior vitreous detachment and acute vitreous hemorrhage appropriate examination and follow-up501MIPS CQM--------------------
Improvement or Maintenance of Functioning for Individuals with a Mental and/or Substance Use Disorder502MIPS CQM--------------------
Gains in Patient Activation Measure (PAM) Scores at 12 Months503MIPS CQM--------------------
Initiation, Review, And/Or Update To Suicide Safety Plan For Individuals With Suicidal Thoughts, Behavior, Or Suicide Risk504MIPS CQM--------------------
Reduction in Suicidal Ideation or Behavior Symptoms505MIPS CQM--------------------

Register with MDinteractive