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Your group reads thousands of studies, sends clean claims, and still gets a quality score that hides the care you deliver. The cause is rarely clinical. It sits in dictation templates, dropped quality data codes (QDCs), and benchmark math few imaging practices ever see.
This guide sets out radiology MIPS strategies grounded in current CMS Quality Payment Program specifications. You will learn which measures fit, what each final report must say, how claims carry the data, and when an MVP changes the math. Every rule traces back to a CMS source.
Most diagnostic radiology measures are scored on topped-out benchmarks, where 84% performance earns 1 point and 100% earns 10. A few incomplete reports can erase several points per measure.
A missing phrase on 3% of cases drops a topped-out measure from 10 points to roughly 7.
The working set is measures 145, 360, 364, 405, 406 and eCQM 494, plus registry measures QMM17, QMM18 and QMM26. Measure 436 is retired. Several older guides still list it.
| Measure | What the final report must show | Claims QDCs | Scoring watch-out |
| 145 (Fluoroscopy exposure dose indices) | Named quantity: Ka,r, PKA/DAP or PSD with unit | G9500 met; G9501 not met | Claims or MIPS CQM |
| 405 (Incidental abdominal lesions) | Explicit statement that no follow-up imaging is recommended | G9547 + G9548 met; G9547 + G9549 exception; G9547 + G9550 not met; G9551 exclusion | Topped-out scale as MIPS CQM only |
| 406 (Incidental thyroid nodule under 1.0 cm) | Follow-up not recommended (inverse measure) | G9552 + G9556 better result; G9552 + G9554 counts against you; G9552 + G9555 exception; G9557 exclusion | Topped-out scale for claims and CQM |
| 360 (High-dose CT and cardiac nuclear count) | Registry abstraction | MIPS CQM only | Topped-out scale |
| 364 (Incidental pulmonary nodule follow-up CT) | Guideline-based recommendation | MIPS CQM only | Topped-out scale |
| 494 (CT dose and image quality) | Electronic capture | eCQM only | Only outcome measure in the radiology MVP |
Measures 145 and 405 carry no ICD-10-CM diagnosis requirement. Eligibility runs on CPT codes such as 76000, 77002 and 77003 for fluoroscopy and 74176-74178 for abdomen and pelvis CT.
Build measure language into structured report macros that fire at sign-off. Specification wording, not clinical intent, decides which code gets billed.
Document the medical reason (active cancer, lymphadenopathy, multiple endocrine neoplasia) whenever follow-up is advised. That turns a miss into a denominator exception.
Claims reporting is open only to small practices. The QDC must ride on the original claim with the eligible CPT code, same patient, same date and same individual (Type 1) NPI, and it cannot be added later.
A remittance advice check catches most leaks:
Remittance reviews surface the same denial patterns CMS documents in its Part B claims quick start guide: a QDC split from its CPT line, a wrong place of service code, or a QDC with no eligible procedure on the claim. Our guide to QDC types explains each code category.
Default weights are Quality 30%, Cost 30%, Improvement Activities 15% and Promoting Interoperability 25%. Most radiologists see Quality climb to 55% or 85% once PI or Cost drops out.
At 85% weight, each of six measures carries roughly 14 final-score points. One weak measure becomes a payment adjustment risk.
The Diagnostic Radiology MVP trims reporting to four quality measures and one improvement activity, with MSPB_1 as the cost measure. It suits groups able to capture eCQM 494, the pathway’s only outcome measure.
The CMS finalized MVPs guide lists every measure and activity. Our MIPS reporting program handles MVP registration.
Pick activities still in the current inventory and audit QDC capture every month. IA_CC_1 (specialist reports back to referrers) and IA_CC_2 (timely test-result communication) were removed. Several older guides still recommend both.
Our clean-claims checklist covers upstream billing fixes that feed these audits.
Radiology quality scores rarely suffer from clinical care. They suffer from report wording, unpaired QDCs, and a pathway chosen without the math. Lock the dictation macros for measures 145, 405 and 406. Reconcile every N620 line on your remittance advice. Confirm your reweighting status and settle the Diagnostic Radiology MVP decision before registration closes. Each fix you make now applies to every claim left in the performance period.
Share one month of remittance files and report macros. We map every QDC gap against current CMS specifications.
Book a Radiology MIPS Review
A final score of 75 points avoids a negative adjustment. Scores at or below 18.75 draw the maximum −9% cut. CMS scales positive adjustments for budget neutrality.
Yes. MIPS CQM and eCQM submissions cover every qualifying patient regardless of payer. Medicare Part B claims measures capture Medicare patients only.
CMS scores the highest-scoring required measures. A measure sent through two collection types counts once, at the higher score. Extra measures work as a safety buffer.
Preliminary performance feedback appears on the QPP website in February after the performance year ends. Sign in to review measure-level results.
CMS may reweight affected categories when a written agreement proves delegated submission. Documentation must reach CMS by November 1 of the year before the payment year.
Compliance note:
This article is educational and reflects CMS materials current at review. It is not legal, coding or billing advice. Results depend on your data, and no MIPS score is guaranteed. Confirm codes against the measure specifications in effect for your dates of service.
