2025 MSK Measure Specifications

2025 MSK Measure Specifications

Measure ID: MSK1

Measure Title:
Patients Suffering From a Neck Injury who Improve Physical Function

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Measure Description: 

• Percentage of patients 18 years or older suffering from a neck injury who achieve the Minimal Clinically Important Difference (MCID) in the Neck Disability Index (NDI) or PROMIS Pain Interference, or like mapped measure during the performance year. 
• Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.
• This measure will include one rate:some text
  • 1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in NDI/PROMIS Pain Interference/or like mapped measure.

Denominator:
The total number of all patients 18 years or older at the time of the initial evaluation or start of care with a neck injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.

Numerator:
The total number of patients with neck injuries to achieve an MCID in their NDI change score (> or = to -7.5) or ( > or = -2) in PROMIS Pain Interference change score or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.

Denominator Exclusions:
Patients who did not complete 2 or more surveys. Patients that are non-English speaking and translation services are unavailable. Patients that have a mental or cognitive impairment that compromises their ability to accurately complete the MIPS patient-reported outcome (PRO). Patients that have a life expectancy of 6 months or less. Patients meeting Medicare requirements for maintenance therapy, such as the maintenance of functional status or prevention of a slow deterioration in function, as defined by the Medicare Benefits Policy Manual, Chapter 15

Denominator Exceptions:
Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only, or discharged due to significant decline in medical status as documented in the medical record). PT/OT can use their clinical judgment to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity/complexities present to qualify for this exception.

Numerator Exclusions: None

Inverse Measure: No

Overall Performance Rate: 1st Performance Rate

Measure Risk Adjusted: Yes

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Measure ID: MSK2

Measure Title: Patients Suffering From an Upper Extremity Injury who Improve Physical Function

Measure Description: 

• Percentage of patients 18 years or older suffering from an upper extremity injury who achieve the Minimal Clinically Important Difference (MCID) in the Quick Disabilities of the Arm, Shoulder and Hand (QDASH) or PROMIS Upper Extremity, or like mapped measure during the performance year. 
• Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.
• This measure will include one rate:some text
  • 1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in QDASH/PROMIS Upper Extremity/or like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with an upper extremity injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.

Numerator: The total number of patients with upper extremity injuries to achieve an MCID in their QDASH change score (> or = to -8) or (> or = 2.1) in PROMIS Upper Extremity change score or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.

Denominator Exclusions: Patients who did not complete 2 or more surveys. Patients that are non-English speaking and translation services are unavailable. Patients that have a mental or cognitive impairment that compromises their ability accurately complete the MIPS patient-reported outcome (PRO). Patients that have a life expectancy of 6 months or less. Patients meeting Medicare requirements for maintenance therapy, such as the maintenance of functional status or prevention of a slow deterioration in function, as defined by the Medicare Benefits Policy Manual, Chapter 15

Denominator Exceptions: Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only, or discharged due to significant decline in medical status as documented in the medical record). PT/OT can use their clinical judgment to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity/complexities present to qualify for this exception.

Numerator Exclusions: None

Inverse Measure: No

Overall Performance Rate: 1st Performance Rate

Measure Risk Adjusted: Yes

Measure ID: MSK3

Measure Title: Patients Suffering From a Back Injury who Improve Physical Function

Measure Description:

• Percentage of patients 18 years or older suffering from a back injury who achieve the Minimal Clinically Important Difference (MCID) in the Modified Low Back Pain Disability Questionnaire (MDQ) or PROMIS Pain Interference, or like mapped measure during the performance year. 
• Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.
• This measure will include one rate:some text
  • 1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in MDQ/PROMIS Pain Interference/or like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with a back injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.

Numerator: The total number of patients with back injuries to achieve an MCID in their MDQ change score (> or = to -6) or (> or = -2) in PROMIS Pain Interference change score or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.

Denominator Exclusions: Patients who did not complete 2 or more surveys. Patients that are non-English speaking and translation services are unavailable. Patients that have a mental or cognitive impairment that compromises their ability accurately complete the MIPS patient-reported outcome (PRO). Patients that have a life expectancy of 6 months or less. Patients meeting Medicare requirements for maintenance therapy, such as the maintenance of functional status or prevention of a slow deterioration in function, as defined by the Medicare Benefits Policy Manual, Chapter 15

Denominator Exceptions: Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only, or discharged due to significant decline in medical status as documented in the medical record). PT/OT can use their clinical judgment to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity/complexities present to qualify for this exception.

Numerator Exclusions: None

Inverse Measure: No

Overall Performance Rate: 1st Performance Rate

Measure Risk Adjusted: Yes

Measure ID: MSK4

Measure Title: Patients Suffering From a Lower Extremity Injury who Improve Physical Function

Measure Description:

• Percentage of patients 18 years or older suffering from a lower extremity injury who achieve the Minimal Clinically Important Difference (MCID) in the Lower Extremity Functional Scale (LEFS) or PROMIS Physical Function, or like mapped measure during the performance year. 
• Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.
• This measure will include one rate:some text
  • 1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in LEFS/PROMIS Physical Function/or like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with a lower extremity injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.

Numerator: The total number of patients with lower extremity injuries to achieve an MCID in their LEFS change score (> or = to 9) or (> or = 2.1) in PROMIS Physical Function change score or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.

Denominator Exclusions: Patients who did not complete 2 or more surveys. Patients that are non-English speaking and translation services are unavailable. Patients that have a mental or cognitive impairment that compromises their ability accurately complete the MIPS patient-reported outcome (PRO). Patients that have a life expectancy of 6 months or less. Patients meeting Medicare requirements for maintenance therapy, such as the maintenance of functional status or prevention of a slow deterioration in function, as defined by the Medicare Benefits Policy Manual, Chapter 15

Denominator Exceptions: Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only, or discharged due to significant decline in medical status as documented in the medical record). PT/OT can use their clinical judgment to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity/complexities present to qualify for this exception.

Numerator Exclusions: None

Inverse Measure: No

Overall Performance Rate: 1st Performance Rate

Measure Risk Adjusted: Yes

Measure ID: MSK5

Measure Title: Patients Suffering From a Knee Injury who Improve Physical Function

Measure Description:

• Percentage of patients 18 years or older suffering from a knee injury who achieve the Minimal Clinically Important Difference (MCID) in the Knee Outcome Survey (KOS) or PROMIS Physical Function, or like mapped measure during the performance year. 
• Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.
• This measure will include one rate:some text
  • 1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in KOS/PROMIS Physical Function/or like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with a knee injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.

Numerator: The total number of patients with knee injuries to achieve an MCID in their KOS change score (> or = to 10) or (> or = 2.1) in PROMIS Physical Function change score or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.

Denominator Exclusions: Patients who did not complete 2 or more surveys. Patients that are non-English speaking and translation services are unavailable. Patients that have a mental or cognitive impairment that compromises their ability accurately complete the MIPS patient-reported outcome (PRO). Patients that have a life expectancy of 6 months or less. Patients meeting Medicare requirements for maintenance therapy, such as the maintenance of functional status or prevention of a slow deterioration in function, as defined by the Medicare Benefits Policy Manual, Chapter 15

Denominator Exceptions: Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only, or discharged due to significant decline in medical status as documented in the medical record). PT/OT can use their clinical judgment to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity/complexities present to qualify for this exception.

Numerator Exclusions: None

Inverse Measure: No

Overall Performance Rate: 1st Performance Rate

Measure Risk Adjusted: Yes

Measure ID: MSK6

Measure Title: Patients Suffering From a Neck Injury who Improve Pain

Measure Description:

• Percentage of patients 18 years or older suffering from a neck injury who achieve the Minimal Clinically Important Difference (MCID) in the Numeric Pain Rating Scale, or like mapped measure during the performance year. 
• Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.
• This measure will include one rate:some text
  • 1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in the Numeric Pain Rating Scale like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with a neck injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.

Numerator: The total number of patients with neck injuries to achieve an MCID in their Numeric Pain Rating Scale change score (MCID > or = to 2) or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.

Denominator Exclusions: Patients who did not complete 2 or more surveys. Patients that are non-English speaking and translation services are unavailable. Patients that have a mental or cognitive impairment that compromises their ability accurately complete the MIPS patient-reported outcome (PRO). Patients that have a life expectancy of 6 months or less. Patients meeting Medicare requirements for maintenance therapy, such as the maintenance of functional status or prevention of a slow deterioration in function, as defined by the Medicare Benefits Policy Manual, Chapter 15

Denominator Exceptions: Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only, or discharged due to significant decline in medical status as documented in the medical record). PT/OT can use their clinical judgment to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity/complexities present to qualify for this exception.

Numerator Exclusions: None

Inverse Measure: No

Overall Performance Rate: 1st Performance Rate

Measure Risk Adjusted: Yes

Measure ID: MSK7

Measure Title: Patients Suffering From an Upper Extremity Injury who Improve Pain

Measure Description:

• Percentage of patients 18 years or older suffering from an upper extremity injury who achieve the Minimal Clinically Important Difference (MCID) in the Numeric Pain Rating Scale, or like mapped measure during the performance year. 

• Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.
• This measure will include one rate:some text
  • 1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in the Numeric Pain Rating Scale like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with an upper extremity injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.

Numerator: The total number of patients with upper extremity injuries to achieve an MCID in their Numeric Pain Rating Scale change score (MCID > or = to 2) or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.

Denominator Exclusions: Patients who did not complete 2 or more surveys. Patients that are non-English speaking and translation services are unavailable. Patients that have a mental or cognitive impairment that compromises their ability accurately complete the MIPS patient-reported outcome (PRO). Patients that have a life expectancy of 6 months or less. Patients meeting Medicare requirements for maintenance therapy, such as the maintenance of functional status or prevention of a slow deterioration in function, as defined by the Medicare Benefits Policy Manual, Chapter 15

Denominator Exceptions: Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only, or discharged due to significant decline in medical status as documented in the medical record). PT/OT can use their clinical judgment to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity/complexities present to qualify for this exception.

Numerator Exclusions: None

Inverse Measure: No

Overall Performance Rate: 1st Performance Rate

Measure Risk Adjusted: Yes

Measure ID: MSK8

Measure Title: Patients Suffering From a Back Injury who Improve Pain

Measure Description:

• Percentage of patients 18 years or older suffering from a back injury who achieve the Minimal Clinically Important Difference (MCID) in the Numeric Pain Rating Scale, or like mapped measure during the performance year. 
• Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level
• This measure will include one rate:some text
  • 1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in the Numeric Pain Rating Scale like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with a back injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.

Numerator: The total number of patients with back injuries to achieve an MCID in their Numeric Pain Rating Scale change score (MCID > or = to 2) or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.

Denominator Exclusions: Patients who did not complete 2 or more surveys. Patients that are non-English speaking and translation services are unavailable. Patients that have a mental or cognitive impairment that compromises their ability accurately complete the MIPS patient-reported outcome (PRO). Patients that have a life expectancy of 6 months or less. Patients meeting Medicare requirements for maintenance therapy, such as the maintenance of functional status or prevention of a slow deterioration in function, as defined by the Medicare Benefits Policy Manual, Chapter 15

Denominator Exceptions: Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only, or discharged due to significant decline in medical status as documented in the medical record). PT/OT can use their clinical judgment to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity/complexities present to qualify for this exception.

Numerator Exclusions: None

Inverse Measure: No

Overall Performance Rate: 1st Performance Rate

Measure Risk Adjusted: Yes

Measure ID: MSK9

Measure Title: Patients Suffering From a Lower Extremity Injury who Improve Pain

Measure Description:

• Percentage of patients 18 years or older suffering from a lower extremity injury who achieve the Minimal Clinically Important Difference (MCID) in the Numeric Pain Rating Scale, or like mapped measure during the performance year. 
• Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.
• This measure will include one rate:some text
  • 1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in the Numeric Pain Rating Scale like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with a lower extremity injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.

Numerator: The total number of patients with lower extremity injuries to achieve an MCID in their Numeric Pain Rating Scale change score (MCID > or = to 2) or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.

Denominator Exclusions: Patients who did not complete 2 or more surveys. Patients that are non-English speaking and translation services are unavailable. Patients that have a mental or cognitive impairment that compromises their ability accurately complete the MIPS patient-reported outcome (PRO). Patients that have a life expectancy of 6 months or less. Patients meeting Medicare requirements for maintenance therapy, such as the maintenance of functional status or prevention of a slow deterioration in function, as defined by the Medicare Benefits Policy Manual, Chapter 15

Denominator Exceptions: Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only, or discharged due to significant decline in medical status as documented in the medical record). PT/OT can use their clinical judgment to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity/complexities present to qualify for this exception.

Numerator Exclusions: None

Inverse Measure: No

Overall Performance Rate: 1st Performance Rate

Measure Risk Adjusted: Yes

Measure ID: MSK10

Measure Title: Patients Suffering From a Knee Injury who Improve Pain

Measure Description:

• Percentage of patients 18 years or older suffering from a knee injury who achieve the Minimal Clinically Important Difference (MCID) in the Numeric Pain Rating Scale, or like mapped measure during the performance year. 
• Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.
• This measure will include one rate:some text
  • 1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in the Numeric Pain Rating Scale like mapped measure."

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with a knee injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.

Numerator: The total number of patients with knee injuries to achieve an MCID in their Numeric Pain Rating Scale change score (MCID > or = to 2) or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.

Denominator Exclusions: Patients who did not complete 2 or more surveys. Patients that are non-English speaking and translation services are unavailable. Patients that have a mental or cognitive impairment that compromises their ability accurately complete the MIPS patient-reported outcome (PRO). Patients that have a life expectancy of 6 months or less. Patients meeting Medicare requirements for maintenance therapy, such as the maintenance of functional status or prevention of a slow deterioration in function, as defined by the Medicare Benefits Policy Manual, Chapter 15

Denominator Exceptions: Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only, or discharged due to significant decline in medical status as documented in the medical record). PT/OT can use their clinical judgment to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity/complexities present to qualify for this exception.

Numerator Exclusions: None

Inverse Measure: No

Overall Performance Rate: 1st Performance Rate

Measure Risk Adjusted: Yes

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Functional Status Change For Patients With Vestibular Dysfunction, (Dizziness Handicap Inventory)

Measure ID: HM7

Measure Title: Functional Status Change for Patients with Vestibular Dysfunction.

Measure Description: Percentage of patients aged 14 years and older diagnosed with vestibular dysfunction who 

achieve a Minimal Clinically Important Difference (MCID) to indicate functional, emotional, and physical 

improvement.

• Submission Age Criteria 1: Patients aged 14-17 years of age
• Submission Age Criteria 2: Patients aged 18-64 years of age
• Submission Age Criteria 3: Patients aged 65 years and older
• Submission Criteria 4: Overall total rate of patients aged 14 years and older
• Submission Risk Adjusted Criteria 5: Overall total rate of patients aged 14 and older.

The measure is adjusted to patient characteristics known to be associated with functional status and quality of life

outcomes (risk-adjusted) and used as a performance measure at the patient level, at the individual clinician, and at 

the clinic level to assess quality.

Denominator Description: Denominator Criteria (Eligible Cases):

SUBMISSION CRITERIA 1: Patients aged 14-17 years of age on date of encounter
SUBMISSION CRITERIA 2: Patients aged 18-64 years and older on date of encounter
SUBMISSION CRITERIA 3: Patients aged 65 years of age and older on date of encounter
SUBMISSION CRITERIA 4: Patients aged 14 years of age and older on date of encounter
AND

A diagnosis of vestibular dysfunction diagnosis (ICD-10-CM): BPPV: H81.10, H81.11, H81.12, H81.
OR
Dizziness: R42, H81.10, H81.11, H81.12, H81.13,
OR
Disorders of vestibular function: H81*
OR
Vertiginous syndromes: H82*
OR
Other diseases of inner ear: H83*
OR
Abnormalities of gait and mobility: R26*

OR
Other lack of coordination: R27*

OR
Repeated falls: R29.6
OR
Concussion: S06.0*, F07.81
OR
History of falling: Z91.81
OR
Epidemic vertigo: A88.1
OR
Benign neoplasm of cranial nerves: D33.3
OR
Migraine: B43.109, G43.819

AND

An Index Patient Visit Indicator:
Physical Therapy CPT: 97161, 97162, 97163
OR
Occupational Therapy CPT: 97165, 97166, 97167

AND

Two face-to-face patient encounters for a treatment episode that began or ended during the performance period.

Numerator Description: Patients who achieved a MCID in vestibular dysfunction, as measured via the validated 

Dizziness Handicap Inventory or equivalent instrument, to indicate functional improvement greater than zero and

a Risk Adjusted Functional Status Change Residual Score for the dizziness handicap successfully calculated with an

 MCID score that is greater than zero from their initial visits and just prior to or at their discharge visits from the 

PT/OT practice.

Denominator Exclusions: Hospice services received by patient at any time during the performance period OR 

Patient unable to complete a DHI or equivalent instrument at admission and discharge due to blindness, illiteracy, 

severe mental incapacity or language incompatibility without the availability of an adequate proxy available.

Denominator Exceptions: N/A

NQF Number: N/A

NQS Domain: Effective Clinical Care

Includes Telehealth: Yes

High Priority Measure: Yes

High Priority Type: Outcome

Measure Type: Patient Reported Outcome

Meaningful Measure Area: Functional Outcomes

Inverse Measure: No

Proportional Measure: Yes

Continuous Variable Measure: No

Ratio Measure: No

Number of performance rates to be submitted: 4

Measure Risk-Adjusted?  Yes

Care Setting(s): Ambulatory Care, Clinician Office / Clinic

*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 are counted in the denominator population for MIPS.

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