Quality Payment Program Measures by ICD-10-CM Code ICD-10-CM
Quality measures quantify healthcare processes and outcomes under Medicare's Quality Payment Program. When a diagnosis on a claim matches a measure's linked ICD-10-CM codes, that measure can apply to the encounter, so knowing which measures ride on which codes matters for MIPS reporting. This reference lists 13 measures with linked diagnosis codes, 10 of them high priority, each with its submission methods and every linked code.
- Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk PatientsQuality ID #320High Priority1 linked codes
Percentage of patients aged 45 to 75 years of age receiving a screening colonoscopy without biopsy or polypectomy who had a recommended follow-up interval of 10 years for repeat colonoscopy documented in their colonoscopy report.
ClaimsRegistry Percentage of esophageal biopsy reports that document the presence of Barrett's mucosa that also include a statement about dysplasia.
ClaimsRegistry- Communication with the Physician or Other Clinician Managing On-Going Care Post-Fracture for Men and Women Aged 50 Years and OlderQuality ID #024High Priority3558 linked codes
Percentage of patients aged 50 years and older treated for a fracture with documentation of communication, between the physician treating the fracture and the physician or other clinician managing the patient’s on-going care, that a fracture occurred and that the patient was or should be considered for osteoporosis treatment or testing. This measure is submitted by the physician who treats the fracture and who therefore is held accountable for the communication.
ClaimsRegistry Percentage of patients 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (<140/90mmHg) during the measurement period.
ClaimsElectronic Health RecordRegistryPercentage of patients 18-75 years of age with diabetes who had a glycemic status assessment (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) > 9.0% during the measurement period.
ClaimsElectronic Health RecordRegistryPathology reports based on lung biopsy and/or cytology specimens with a diagnosis of primary non-small cell lung cancer classified into specific histologic type following the International Association for the Study of Lung Cancer (IASLC) guidance or classified as non-small cell lung cancer not otherwise specified (NSCLC-NOS) with an explanation included in the pathology report.
ClaimsRegistryPathology reports based on lung resection specimens with a diagnosis of primary lung carcinoma that include the pT category, pN category and for non-small cell lung cancer (NSCLC), histologic type.
ClaimsRegistryPathology reports for primary malignant cutaneous melanoma that include the pT category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors.
ClaimsRegistryThe percentage of women 50-85 years of age who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat osteoporosis in the 180 days after the fracture.
ClaimsRegistry- Performing Cystoscopy at the Time of Hysterectomy for Pelvic Organ Prolapse to Detect Lower Urinary Tract InjuryQuality ID #422High Priority8 linked codes
Percentage of patients who undergo cystoscopy to evaluate for lower urinary tract injury at the time of hysterectomy for pelvic organ prolapse.
ClaimsRegistry - Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 20% OR Documentation of a Plan of Care.Quality ID #141High Priority27 linked codes
Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) whose glaucoma treatment has not failed (the most recent IOP was reduced by at least 20% from the pre-intervention level) OR if the most recent IOP was not reduced by at least 20% from the pre-intervention level, a plan of care was documented within the 12 month performance period.
ClaimsRegistry Percentage of radical prostatectomy pathology reports that include the pT category, the pN category, the Gleason score and a statement about margin status.
ClaimsRegistry- Referral for Otologic Evaluation for Patients with Acute or Chronic DizzinessQuality ID #261High Priority5 linked codes
Percentage of patients aged birth and older referred to a physician (preferably a physician specially trained in disorders of the ear) for an otologic evaluation subsequent to an audiologic evaluation after presenting with acute or chronic dizziness.
ClaimsRegistry
Questions About Quality Measures
What is a Quality Payment Program measure?
A quality measure quantifies a healthcare process, outcome, or patient experience under Medicare's Quality Payment Program. Clinicians in MIPS report performance on a set of measures, and that performance affects their Medicare payment adjustment.
What does high priority mean?
CMS designates certain measures as high priority: outcome, appropriate use, patient safety, efficiency, patient experience, and care coordination measures. MIPS scoring rules reward including high-priority measures in a submission.
How do the linked ICD-10-CM codes work?
Each measure applies to encounters with specific diagnoses. When one of the linked codes appears on a claim, the measure can apply to that patient, so the diagnosis coding drives which quality measures a practice can report.
Related References
Source: Centers for Medicare & Medicaid Services, Quality Payment Program measure specifications, with linked codes validated against the official FY 2027 ICD-10-CM code set.
