What Pathologists Need to Know for MIPS 2023

January 4, 2023

For 2023, there are 7 measures available through CMS for pathologists to earn points in the MIPS program. One revision, one new measure, and the retained measures are listed here.

The reporting requirements of this measure have not changed. The update is the addition of HCPCS® code M1166, which has been created to accurately account for wide local excisions or re-excisions which are not held to the 7 calendar day turnaround time.

NEW MEASURE 491 – MMR/MSI Testing Status in Colorectal, Endometrial, Gastroesophageal, or Small Bowel Carcinoma 
Percentage of surgical pathology reports for primary colorectal, endometrial, gastroesophageal or small bowel carcinoma, biopsy or resection, that contain impression or conclusion of or recommendation for testing of mismatch repair (MMR) by immunohistochemistry (biomarkers MLH1, MSH2, MSH6, and PMS2), or microsatellite instability (MSI) by DNA-based testing status, or both.

Documentation required to meet this measure:
The pathology report must have MMR or MSI test results OR a statement that mentions MMR or MSI testing recommendations. Qualifying statement example verbiage (not all-inclusive):
•    After review, specimen A will be sent for MMR/MSI testing
•    Specimen A is not recommended for MMR/MSI testing due to (reason)
•    MMR/MSI testing performed on previous biopsy (reference accession)

Exclusions from the measure:
•    Patients with existing diagnosis of Lynch Syndrome
•    Patients with existing diagnosis of squamous cell carcinoma of the esophagus
•    Hospice services provided to patient at any time during the measurement period
•    Other medical reason documented – e.g. patient will not be treated with checkpoint inhibitor therapy, no residual carcinoma (tissue exhausted or status post neoadjuvant treatment), insufficient tumor for testing

•    249 Barrett’s Esophagus
•    250 Radical Prostatectomy
•    395 Lung Cancer Biopsy/Cytology
•    396 Lung Cancer Resections
•    397 Melanoma Reporting

Full measure details are available from CMS.


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