2026 MIPS Measure #288: Dementia: Education and Support of Caregivers for Patients with Dementia

Measure Description

Percentage of patients with dementia whose caregiver(s) were provided with education on dementia disease management and health behavior changes AND were referred to additional resources for support in the last 12 months.

Instructions

Intent and Clinician Applicability: This measure is intended to reflect the quality of services provided for patients with dementia. This measure may be submitted by that 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: 

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 re

Denominator

All patients with dementia

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

Diagnosis for dementia (ICD-10-CM): A52.17, A81.00, A81.01, A81.89, F01.50, F01.511, F01.518, F01.52, F01.53, F01.54, F01.A0, F01.A11, F01.A18, F01.A2, F01.A3, F01.A4, F01.B0, F01.B11, F01.B18, F01.B2, F01.B3, F01.B4, F01.C0, F01.C11, F01.C18, F01.C2, F01.C3, F01.C4, F02.80, F02.811, F02.818, F02.82, F02.83, F02.84, F02.A0, F02.A11, F02.A18, F02.A2, F02.A3, F02.A4, F02.B0, F02.B11, F02.B18, F02.B2, F02.B3, F02.B4, F02.C0, F02.C11, F02.C18, F02.C2, F02.C3, F02.C4, F03.90, F03.911, F03.918, F03.92, F03.93, F03.94, F03.A0, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B0, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C0, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, F10.27, G30.0, G30.1, G30.8, G30.9, G31.01, G31.09, G31.83, G31.85, G31.89, G94

AND

Patient encounter during the performance period (CPT or HCPCS): 78811, 78814, 90791, 90792, 90832, 90834, 90837, 92507, 92508, 92526, 96116, 96130, 96132, 96136, 96138, 96146, 96156, 96158, 96164, 96167, 96170*, 97129, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97550, 97552, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99424, 99426, 99487, 99490, 99491, 99497, A9586, A9601, Q9982, Q9983

Numerator

Patients with dementia whose caregiver(s) were provided with education on dementia disease management and health behavior changes AND were referred to additional resources for support in the last 12 months

Definitions:

Caregiver – Is broadly defined and the Work Group adopted the definition utilized by the National Quality Forum and Feinberg. (1) “Caregiver” refers to any relative, partner, friend, or neighbor who has a significant relationship with, and who provides a broad range of assistance for, an older adult or an adult with chronic or disabling conditions.(1)

Education – Requires learning and processing information about disease management and health behavior changes. This should also include advising the caregiver that, as a caregiver, he or she is at “increased risk of serious illness (including circulatory and heart conditions and respiratory disease and hypertension), increased physician visits and use of prescription medications, emotional strain, anxiety, and depression.”(2) Providers are encouraged to review state specific guidelines to ensure education is being provided as required.

Additional Resources – Are defined as situation-specific, tailored programs to assist the caregiver; these included national organizations such as the Alzheimer’s Association, but also include local resources, such as community, senior center and religion-based support groups.

Numerator Instructions:

There are a number of assessment tools available for the caregiver. These should be considered as an integral component of comprehensive caregiver education and support. The American Medical Association has developed a Caregiver Health Self-assessment Questionnaire to help caregivers analyze their own behavior and health risks and, with their physician's help, make decisions that will benefit both the caregiver and the patient. This questionnaire can be found on the Health In Aging website by searching “Caregiver Self Assessment.”

NUMERATOR NOTE: The 12 month look back period is defined as 12 months from the date of the denominator eligible encounter. Denominator Exception(s) are determined on the date of the denominator eligible encounter.

Numerator Options:

Performance Met: Caregiver provided with education and referred to additional resources for support (4322F)

OR

Denominator Exception: Patient does not have a caregiver (G2184)

OR

Denominator Exception: Documentation caregiver is trained and certified in dementia care (G2185)

OR

Denominator Exception: Patient/caregiver dyad has been referred to appropriate resources and connection to those resources is confirmed (G2186)

OR

Performance Not Met: Caregiver not provided with education and not referred to additional resources for support, reason not otherwise specified (4322F with 8P)

Rationale

By providing education as well as resources to caregivers it is anticipated that caregiver will act on information received connecting to support networks and gain a greater understanding of dementia. As a result, caregiver burden will decrease, caregiver and patient Quality of Life will improve, and caregiver and patient physical health will improve.

Clinical Recommendation Statements

“Important aspects of psychiatric management include educating patients and families about the illness, its treatment, and sources of additional care and support (e.g., support groups, respite care, nursing homes, and other long-term-care facilities) and advising patients and their families of the need for financial and legal planning due to the patient’s eventual incapacity (e.g., power of attorney for medical and financial decisions, an up-to-date will, and the cost of longterm care) (Category I)… The family should be educated regarding basic principles of care, including

1. recognizing declines in capacity and adjusting expectations appropriately,
2. bringing sudden declines in function and the emergence of new symptoms to professional attention,
3. keeping requests and demands relatively simple,
4. deferring requests if the patient becomes overly upset or angered,
5. avoiding overly complex tasks that may lead to frustration,
6. not confronting patients about their deficits,
7. remaining calm, firm, and supportive and providing redirection if the patient becomes upset,
8. being consistent and avoiding unnecessary change, and
9. providing frequent reminders, explanations, and orientation cues… In addition to providing families with information on support groups, there are a number of benefits of referral to the local chapter or national office of the Alzheimer’s Association (1-800-272-3900; http://www.alz.org), the Alzheimer’s Disease Education and Referral Center (ADEAR) (1-800-438-4380; http://www.nia.nih.gov/Alzheimers/), and other support organizations.”(3)

• “Short-term programs directed toward educating family caregivers about AD should be offered to improve caregiver satisfaction” (4).
• “Intensive long-term education and support services (when available) should be offered to caregivers of patients with AD to delay time to nursing home placement” (4).
• “Staff of long-term care facilities should receive education about AD to reduce the use of unnecessary antipsychotics” (4)
• "Support programs for caregivers and patients with dementia significantly decreased the odds of institutionalization and improved caregiver well-being." (5)
• “A dementia diagnosis mandates an inquiry to the community for available public health care support programmes (Good Practice Point). Counselling and case/care management amongst caring family members have positive effects on burden and satisfaction for caregivers of people with dementia (Good Practice Point).” (6)
• “Following a diagnosis of dementia, health and social care professionals should, unless the person with dementia clearly indicates to the contrary, provide, them and their family with written information about

1. The signs and symptoms of dementia
2. The course and prognosis of the condition
3. Treatments
4. Local care and support services
5. Support groups
6. Sources of financial and legal advice, and advocacy
7. Medico-legal issues, including driving
8. Local information sources, including libraries and voluntary organisations.” (7)

“…emphasise that professional support should have a wide focus that includes helping family and friends to support the person with dementia, rather than being limited to an exclusive and direct focus on the person with dementia.”(8)