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2020 MIPS Measure #464: Otitis Media with Effusion: Systemic Antimicrobials - Avoidance of Inappropriate Use

Quality ID 464
NQF 0657
High Priority Measure Yes
Specifications Registry
Measure Type Process
Specialty Family Medicine Otolaryngology Pediatrics Urgent Care

Measure Description

Percentage of patients aged 2 months through 12 years with a diagnosis of OME who were not prescribed systemic antimicrobials



This measure is to be submitted once for each occurrence of otitis media with effusion (OME) in children seen during the performance period. Each unique occurrence is defined as a 90 day period from onset of OME. If multiple occurrences are documented within a 90 day period, Merit-based Incentive Payment System (MIPS) eligible clinicians should submit one instance.

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 2 months through 12 years with a diagnosis of OME

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):

Patients aged 2 months through 12 years on the date of the encounter


Diagnosis for OME (ICD-10-CM): H65.90, H65.91, H65.92, H65.93, H65.111, H65.112, H65.113, H65.114, H65.115, H65.116, H65.117, H65.119, H65.191, H65.192, H65.193, H65.194, H65.195, H65.196, H65.197, H65.199, H65.411, H65.412, H65.413, H65.419, H65.491, H65.492, H65.493, H65.499


Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*, 99381*, 99382*, 99383*, 99384*, 99391*, 99392*, 99393*, 99394*


Telehealth Modifier: GQ, GT, 95, POS 02



Patients who were not prescribed systemic antimicrobials

Numerator Instructions:

For performance, the measure will be calculated as the number of patients for whom systemic antimicrobials were neither prescribed nor recommended over the number of patients in the denominator (patients aged 2 months through 12 years with a diagnosis of OME). A higher score indicates appropriate treatment of patients with OME (e.g., the proportion for whom systemic antimicrobials were not prescribed).

Numerator Options:

Performance Met: Systemic antimicrobials not prescribed (G9959)


Denominator Exception: Documentation of medical reason(s) for prescribing systemic antimicrobials (G9960)


Performance Not Met: Systemic antimicrobials prescribed (G9961)



OME usually resolves spontaneously with indications for therapy only if the condition is persistent and clinically significant benefits can be achieved. Systemic antimicrobials have no proven long-term effectiveness and have potential adverse effects. The purpose of the corresponding guideline statement is to reduce ineffective and potentially harmful medical interventions in OME when there is no long-term benefit to be gained in the vast majority of cases. Medications have long been used to treat OME, with the dual goals of improving quality of life (QOL) and avoiding more invasive surgical interventions. Both the 1994 guidelines and the 2004 guidelines determined that the weight of evidence did not support the routine use of steroids (either oral or intranasal), antimicrobials, antihistamines, or decongestants as therapy for OME.

Clinical Recommendation Statements

Clinicians should recommend against using systemic antibiotics for treating OME. Strong recommendation based on systematic review of randomized clinical trials (RCTs) and preponderance of harm over benefit [1].

Data detailing the prescription of systemic antimicrobials for OME in children is limited. However, in a small 2008 study by Patel et al., 7% of physicians in an otolaryngology practice prescribed systemic antimicrobials for pediatric patients presenting with OME [2]. In a 2014 study involving 5 focus groups of parents, most parents believed that antibiotics were needed to treat otitis media and expressed frustration with a “watchful waiting” approach [3]. In a 2013 study by Forrest et al. evaluating clinical decision support for management of OME, 78%-93% of physicians employed a “watchful waiting” strategy to manage OME [4]


1. Rosenfeld RM, et al. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngology Head Neck Surg. 2016.

2. Patel MM, Eisenberg L, Witsell D, Schulz KA. Assessment of acute otitis externa and otitis media with effusion performance measures in otolaryngology practices. Otolaryngol Head Neck Surg. 2008;139:490-494.

3. Finkelstein JA, Dutta-Linn M, Meyer R, Goldman R. Childhood infections, antibiotics, and resistance: what are parents saying now? Clin Pediatr (Phila). 2014;53(2):145-150.Doi:10.1177/0009922813505902.

4. Forrest CB, Fiks AG, Bailey LC, et al. Improving adherence to otitis media guidelines with clinical decision support and physician feedback. Pediatrics. 2013;131(4):e1071-e1081.

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