2026 MIPS Measure #102: Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients

Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low (or very low) risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy who did not have a bone scan performed at any time since diagnosis of prostate cancer.

This measure is to be submitted once per performance period for patients with a diagnosis of prostate cancer at low (or very low) risk of recurrence who receive interstitial prostate brachytherapy, external beam radiotherapy to the prostate, radical prostatectomy during the performance period. The quality data code or equivalent needs to be submitted only once during the performance period. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the listed procedures as specified in the denominator coding will submit this measure.

All patients, regardless of age, with a diagnosis of prostate cancer at low (or very low) risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy

Definitions:
Risk Strata: Very Low, Low, Intermediate, High, or Very High

Very Low/Low Risk – PSA 20 ng/mL; OR Gleason score 8 to 10/Gleason grade group 4-5; OR clinically localized stage T3 to T4 (adapted from the National Comprehensive Cancer Network, 2018).

External beam radiotherapy – “external beam radiotherapy” refers to 3D conformal radiation therapy, intensity modulated radiation therapy, stereotactic body radiotherapy, and proton beam therapy.

DENOMINATOR NOTE: Most recent risk assessment of recurrence completed before the first prostate cancer treatment during the performance period will be used for denominator eligibility. In 2022, the American Urological Association published guidance recommending that clinicians not perform bone scan in asymptomatic patients with low or favorable intermediate risk prostate cancer. However, this quality measure remains focused on patients with low (or very low) risk of recurrence.

Any patient, regardless of age

AND

Diagnosis for prostate cancer (ICD-10-CM): C61

AND

Patient encounter during the performance period (CPT): 55810, 55812, 55815, 55840, 55842, 55845, 55866, 55868, 55869, 55875, 55877, 55880, 55881, 55882, 77427, 77435, 77772, 77778, 77799

WITHOUT

Encounters conducted via telehealth: M1426

AND

Low (or very low) risk of recurrence, prostate cancer: G9706

Patients who did not have a bone scan performed at any time since diagnosis of prostate cancer

Bone scan – “bone scan” refers to the conventional technetium-99m-methyl diphosphonate bone scan as well as 18F-sodium fluoride or prostate-specific membrane antigen (PSMA) PET/CT scan.

Numerator Instructions:
A higher score indicates appropriate treatment of patients with prostate cancer at low (or very low) risk of recurrence.

NUMERATOR NOTE: Denominator Exception(s) are determined any time after diagnosis of Prostate Cancer.

Performance Met: Bone scan not performed prior to initiation of treatment nor at any time since diagnosis of prostate cancer (3270F)

OR

Denominator Exception: Documentation of medical reason(s) for performing a bone scan (including documented pain related to prostate cancer, salvage therapy, other medical reasons) (M1427)

OR

Denominator Exception: Documentation of system reason(s) for performing a bone scan (including bone scan ordered by someone other than the reporting physician) (3269F with 3P)

OR

Performance Not Met: Bone scan performed prior to initiation of treatment or at any time since diagnosis of prostate cancer (3269F)

Multiple studies have indicated that a bone scan is not clinically necessary for staging prostate cancer with a low (or very low) risk of recurrence and receiving primary therapy. For patients who are categorized as low-risk, bone scans are unlikely to identify their disease. Furthermore, bone scans are not necessary for low-risk patients who have no history of bony involvement or if the clinical examination suggests no bony involvement. Less than 1% of low-risk patients are at risk of metastatic disease.

While clinical practice guidelines do not recommend bone scans in low-risk prostate cancer patients, overuse is still common. An analysis of prostate cancer patients in the Surveillance, Epidemiology and End Results Medicare database diagnosed from 2004-2007 found that 43% of patients for whom a bone scan was not recommended received it [1]). The analysis also found that the use of bone scans in low-risk patients leads to an annual cost of $4 million dollars to Medicare. The overuse of bone scan imaging for low-risk prostate cancer patients is a concept included on the American Urological Association’s (AUA) list in the Choosing Wisely Initiative as a means to promote adherence to evidence-based imaging practices and to reduce health care dollars wasted [2]. This measure is intended to promote adherence to evidence-based imaging practices, lessen the financial burden of unnecessary imaging, and ultimately to improve the quality of care for prostate cancer patients in the United States.

References:

Falchook, A. D., Hendrix, L. H., & Chen, R. C. (2015). Guideline-discordant use of imaging during work-up of newly diagnosed prostate cancer. Journal of Oncology Practice, 11(2), e239-e246. doi:10.1200/jop.2014.001818
American Urological Association. (2019). A routine bone scan is unnecessary in men with very low-risk or low-risk prostate cancer. Retrieved from http://www.choosingwisely.org/clinician-lists/american-urologicalassociation-routine-bone-scans-with-low-risk-prostate-cancer/ (Original work published in 2013)

For symptomatic patients and/or those with a life expectancy of greater than 5 years, bone imaging is appropriate for patients with unfavorable intermediate-risk prostate cancer, high-risk and very-high-risk prostate cancer (Eastham, et al., 2022) (Evidence Level: Category 2A).

Clinicians should not routinely perform abdominal pelvic computed tomography (CT) scan or bone scan in asymptomatic patients with low- or intermediate-risk prostate cancer. (Expert Opinion) (American Society of Clinical Oncology, 2021)

Don’t perform PET, CT, and radionuclide bone scans, or newer imaging scans in the staging of early prostate cancer at low risk for metastasis.

References:

National Comprehensive Cancer Network. (2022). Clinical Practice Guidelines in Oncology: Prostate Cancer. Version 1.2023. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf
American Urological Association, American Society for Radiation Oncology, & Society of Urologic Oncology. (2017). Clinically localized prostate cancer: AUA/ASTRO/SUO Guideline. Retrieved from https://www.astro.org/uploadedFiles/_MAIN_SITE/Patient_Care/Clinical_Practice_Statements/Content_Pie ces/ClinicallyLocalizedProstateCancer.pdf
American Urological Association. (2019). A routine bone scan is unnecessary in men with very low-risk or low-risk prostate cancer. Retrieved from http://www.choosingwisely.org/clinician-lists/american-urologicalassociation-routine-bone-scans-with-low-risk-prostate-cancer/ (Original work published in 2013)