Codes for Merit-based Incentive Payment System (MIPS) Quality Measures Reporting (2025)
There are no changes in the QPP eligibility criteria. Eligible clinicians must:
- Bill more than $90,000 for Medicare Part B covered professional services, and
- See more than 200 Medicare Part B patients, and
- Provide more than 200 covered professional services to Medicare Part B patients.
To determine if you are an eligible clinician, see: QPP Participation Status Tool.
Note: If you do not meet the criteria above, you may choose to opt-in to the program (and will receive a payment adjustment). Alternatively, you may voluntarily report and track your quality scores.
The maximum payment adjustment remains at +or – 9 percent.
CMS strives to maintain continuity in the Merit-based Incentive Payment System (MIPS) pathway for quality reporting.
–The performance threshold remains at 75 points for the Calendar Year (CY) 2025 performance period/2027 MIPS payment year. The performance threshold is the number against which your final score is compared to determine your payment adjustment.
–CMS maintains the 75 percent data completeness criteria threshold through the 2028 performance period/2030 MIPS payment year. This means you must report on 75 percent of all eligible cases for each measure you choose to report.
CMS Aims to Provide Program Efficiencies by:
–Removing improvement activity weighting and streamlining the reporting requirements for the improvement activity performance category.
–Automatic reweighting of the Promoting Interoperability category for MIPS eligible clinicians, groups, and virtual groups with the following special statuses: • Ambulatory Surgical Center (ASC)-based • Hospital-based • Non-patient facing • Small practices.
Designated Audiology Quality Measures Set
–There are no measures added or deleted for the audiology measures set.
Current audiology measures are:
#130 – Documentation of Current Medications in the Medical Record: Percentage of visits for which the eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.
**This measure was changed to include coding for pediatric audiology services. It was previously limited to adult services.
#134- Preventive Care and Screening: Screening for Depression and Follow-Up Plan: Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of or up to two days after the date of the qualifying encounter.
#155 – Falls: Plan of Care: Percentage of patients aged 65 years and older with a history of falls who had a plan of care for falls documented within 12 months
#181 – Elder Maltreatment Screen and Follow-Up Plan: Percentage of patients aged 60 years and older with a documented elder maltreatment screen using an Elder Maltreatment Screening tool on the date of encounter AND a documented follow-up plan on the date of the positive screen.
#182 – Functional Outcome Assessment: Percentage of visits for patients aged 18 years and older with documentation of a current functional outcome assessment using a standardized functional outcome assessment tool on the date of the encounter AND documentation of a care plan based on identified functional outcome deficiencies within 2 days of the date of the identified deficiencies.
#226 – Tobacco Use: Screening and Cessation Intervention: Percentage of patients aged 12 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention during the measurement period or in the 6 months prior to the measurement period if identified as a tobacco user.
#261 – Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness: 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.
#317 – Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented: Percentage of patient visits for patients aged 18 years and older seen during the measurement period who were screened for high blood pressure AND a recommended follow-up plan is documented, as indicated, if blood pressure is elevated or hypertensive.
#318 – Falls: Screening for Future Fall Risk: Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period.
#431 – Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling: Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 12 months AND who received brief counseling if identified as an unhealthy alcohol user.
#487 – Screening for Social Drivers of Health: Percent of patients 18 years and older screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety.
#498 – Connection to Community Service Provider: Percent of patients 18 years or older who screen positive for one or more of the following health related social needs (HRSNs): food insecurity, housing instability, transportation needs, utility help needs, or interpersonal safety; and had contact with a Community Service Provider (CSP) for at least one of their HRSNs within 60 days after screening.
**MIPS-eligible clinicians may choose any 6 measures to report. Audiologists are not required to report on all measures in the audiology measures set.
RESOURCES
Measure specifications and supporting documentation (such as single source documentation that lets you search for codes that qualify for a given measure) will be posted on the QPP Resource Library before the performance period begins on January 1, 2025. QPP Resource Library
