2026 MIPS Measure #503: Gains in Patient Activation Measure (PAM®) Scores at 12 Months

The Patient Activation Measure® (PAM®) is a 10- or 13- item questionnaire that assesses an individual's knowledge, skills and confidence for managing their health and health care. The measure assesses individuals on a 0-100 scale that converts to one of four levels of activation, from low (1) to high (4). The PAM® performance measure (PAM®-PM) is the change in score on the PAM® from baseline to follow-up measurement.

This measure is to be submitted a minimum of once per performance period for patients, without specific disease, seen during the performance period. This measure is intended to reflect the quality of services provided for patients who received a baseline PAM® score and a second PAM® score in a 4 to 12 month period from the baseline PAM® score. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who provided the measure-specific denominator coding.

Unique to this measure is the Minimum Performance Threshold Requirement. This measure-based threshold includes two requirements:

Clinicians must have collected a follow-up PAM® survey on at least 25% of all eligible patients during the performance period.
Clinicians must have administered a follow-up PAM® survey to a minimum of 50 unique patients.
Therefore, if the performance rate for Submission Criteria 1 is below 25% and does not include 50 unique patients, the MIPS eligible clinician would not be able to meet the denominator of the Submission Criteria 2 and this measure CANNOT BE SUBMITTED. CMS anticipates the performance rate for Submission Criteria 2 and Submission Criteria 3 will be calculated using 100% of patients that met performance in Submission Criteria 1.

The survey will be available at www.phreesia.com/mips. Clinicians will be able to administer the PAM® on paper, via phone, electronically via email, or through a free web portal provided by Phreesia Inc. The portal will allow users to administer the PAM® survey to patients and record a patient’s responses to the survey questions that were administered using other modalities. These responses will be automatically scored. In addition, clinicians will be able to view reports on patient PAM® responses

This measure will be calculated with 3 performance rates:

1) Percentage of patients aged 14 years and older who achieved a net increase in PAM® score of at least 3 points in a 4 to 12 month period.

2) Percentage of patients aged 14 years and older who achieved a net increase in PAM® score of at least 6 points in a 4 to 12 month period.

3) Average change between baseline PAM® score and the second score within 4 to 12 months of a baseline PAM® score.^

NOTE: ^CMS determined that it’s not technologically feasible to calculate the 3rd performance rate using the existing submission JavaScript Object Notation (JSON) structure. As a result, the submission of data for the 3rd stratum won’t be required when reporting the measure. While not required, this data may be captured by the MIPS eligible clinicians, groups, or third-party intermediaries for quality improvement purposes. For accountability reporting in the CMS MIPS program, Submission Criteria 2 will be used for performance.

NOTE: Patient encounters for this measure conducted via telehealth (including but not limited to encounters coded with GQ, GT, POS 02, POS 10) are allowable. Please note that effective January 1, 2025, while a measure may be denoted as telehealth eligible, specific denominator codes within the encounter may no longer be eligible due to changes outlined in the CY 2024 PFS Final Rule List of Medicare Telehealth Services.

Measure Submission Type:
Measure data may be submitted by individual MIPS eligible clinicians, groups, or third-party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third-party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third-party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

THERE ARE FOUR SUBMISSION CRITERIA FOR THIS MEASURE:

1) All patients aged 14 years and older who had two PAM® scores 4 to 12 months apart AND

2) All patients aged 14 years and older who achieved a net increase in PAM® score of at least 3 points AND

3) All patients aged 14 years and older who achieved a net increase in PAM® score of at least 6 points AND

4) Average change in PAM® score^

PAM® MEASURE – DENOMINATOR (SUBMISSION CRITERIA) ONLY – SUMMARY:

SUBMISSION CRITERIA 1 – ALL PATIENTS WHO HAD TWO PAM® SCORES 6 TO 12 MONTHS APART:
- Denominator: Patients aged 14 years and older with at least two qualifying visits during the performance period
- Measure is NOT disease specific – can be used with chronic conditions or no medical diagnosis
- Baseline PAM® score can be captured during current OR prior performance period
- Follow?up PAM® score must be captured during current performance period
- Exclusions: Death, Dementia, Huntington's disease, Cognitive Impairment/Alzheimer's, Delirium, Psychoactive substance abuse

SUBMISSION CRITERIA 2 – ALL PATIENTS AGED 14 YEARS AND OLDER WHO ACHIEVED A NET INCREASE IN PAM® SCORE OF AT LEAST 3 POINTS:
- Denominator: Patients with Performance Met for Submission Criteria 1 (M1345) who had a baseline PAM® score and a second score within 4 to 12 months of baseline AND seen for a qualifying visit at least twice during performance period
- Minimum Process of Care Threshold: At least 25% of all eligible patients had a PAM® score assessed at baseline and 4 to 12 months of baseline (Performance Rate for Submission Criteria 1)
- Minimum Case Threshold: At least 50 eligible patients had a PAM® score assessed at baseline and 4 to 12 months of baseline (M1345)
- Follow?up must occur during performance period (January 1 – December 31)
- Exclusions: Death, Dementia, Huntington's disease, Cognitive Impairment/Alzheimer's

SUBMISSION CRITERIA 3 – ALL PATIENTS AGED 14 YEARS AND OLDER WHO ACHIEVED A NET INCREASE IN PAM® SCORE OF AT LEAST 6 POINTS:
- Denominator: Patients with Performance Met for Submission Criteria 1 (M1345) who had a baseline PAM® score and a second score within 4 to 12 months of baseline AND seen for a qualifying visit at least twice during performance period
- Minimum Process of Care Threshold: At least 25% of all eligible patients had a PAM® score assessed at baseline and 4 to 12 months of baseline (Performance Rate for Submission Criteria 1)
- Minimum Case Threshold: At least 50 eligible patients had a PAM® score assessed at baseline and 4 to 12 months of baseline (M1345)
- Follow?up must occur during performance period (January 1 – December 31)
- Exclusions: Death, Dementia, Huntington's disease, Cognitive Impairment/Alzheimer's

KEY TAKEAWAYS:
1. Submission Criteria 2 and 3 are subsets of Submission Criteria 1
2. Both require minimum 25% process threshold AND minimum 50 case threshold
3. All three criteria use the same patient age requirement (?14 years)
4. All three criteria use the same exclusion diagnoses (Death, Dementia, Huntington's, Cognitive Impairment/Alzheimer's, Delirium, Psychoactive substance abuse)
5. Follow?up PAM® score must be within 4?12 months of baseline
6. Submission Criteria 2 = Net increase of ?3 points (passing)
7. Submission Criteria 3 = Net increase of ?6 points (excellent)

PAM® MEASURE – DENOMINATOR CRITERIA (ELIGIBLE CASES) – ALL 3 SUBMISSION CRITERIA:

SUBMISSION CRITERIA 1 – TWO PAM® SCORES 6 TO 12 MONTHS APART:
- Patients aged ? 14 years on date of encounter
- At least two patient encounters during the performance period using eligible CPT/HCPCS codes:
98000–98016, 99202–99215, 99211, 90834, 90837, 97164–97168,
98966–98968, 99341–99350, 99401*–99403*, 99424, 99484, 99491–99493,
99384*–99387*, 99394*–99397*, G0402, G0438, G0439
- EXCLUDE: Death (M1384), Dementia (M1474), Huntington's disease (M1475),
Cognitive Impairment/Alzheimer's (M1476), Delirium (M1477),
Psychoactive substance abuse (M1478)

SUBMISSION CRITERIA 2 – NET INCREASE ? 3 POINTS:
- Minimum Process of Care: ? 25% of eligible patients had baseline + follow?up PAM® (Performance Rate for Submission Criteria 1)
- Minimum Case Threshold: ? 50 eligible patients had baseline + follow?up PAM® (M1345)
- Patients aged ? 14 years on date of encounter
- All eligible instances when M1345 submitted (Performance Met for Submission Criteria 1)
- At least two patient encounters during performance period using eligible CPT/HCPCS codes:
98000–98016, 99202–99215, 99211, 90834, 90837, 97164–97168,
98966–98968, 99341–99350, 99401*–99403*, 99424, 99484, 99491–99493,
99384*–99387*, 99394*–99397*, G0402, G0438, G0439
- EXCLUDE: Death (M1384), Dementia (M1474), Huntington's disease (M1475),
Cognitive Impairment/Alzheimer's (M1476)

SUBMISSION CRITERIA 3 – NET INCREASE ? 6 POINTS:
- Minimum Process of Care: ? 25% of eligible patients had baseline + follow?up PAM® (Performance Rate for Submission Criteria 1)
- Minimum Case Threshold: ? 50 eligible patients had baseline + follow?up PAM® (M1345)
- Patients aged ? 14 years on date of encounter
- All eligible instances when M1345 submitted (Performance Met for Submission Criteria 1)
- At least two patient encounters during performance period using eligible CPT/HCPCS codes:
98000–98016, 99202–99215, 99211, 90834, 90837, 97164–97168,
98966–98968, 99341–99350, 99401*–99403*, 99424, 99484, 99491–99493,
99384*–99387*, 99394*–99397*, G0402, G0438, G0439
- EXCLUDE: Death (M1384), Dementia (M1474), Huntington's disease (M1475),
Cognitive Impairment/Alzheimer's (M1476)

PAM® MEASURE – NUMERATOR (SUBMISSION CRITERIA) ONLY – ALL 3 CRITERIA:

SUBMISSION CRITERIA 1 – TWO PAM® SCORES 6 TO 12 MONTHS APART:
Patients with a Baseline PAM® score and then a second score taken within 12 months of the baseline (but not less than 4 months).

Definitions:
- Follow-up: The second PAM® score must occur during the performance period (January 1 through December 31).
- Level 4: Scores on the PAM® survey range from 0-100 that are then converted to Levels ranging from Level 1 to "Level 4", with "Level 4" being the highest level of activation.
- Extreme Straight line Response Sets: PAM® surveys where all responses are either 'Agree Strongly' or all responses are 'Disagree Strongly'.
- Excessive Missing Responses: PAM-10® surveys where more than 3 responses are missing OR PAM-13® surveys where more than 4 responses are missing.

Numerator Instructions:
The Baseline PAM® score can be captured during the current performance period or the prior performance period. The follow-up PAM® score should be captured during the current performance period for the purposes of this measure.

SUBMISSION CRITERIA 2 – NET INCREASE IN PAM® SCORE OF AT LEAST 3 POINTS:
Percentage of eligible patients who achieved a net increase in PAM® score of at least 3 points in a 4 to 12 month period (passing).

Definition:
Patient Activation Measure-Performance Measure (PAM®-PM) requires that PAM® be measured at two points in time with the second measure occurring within 4 to 12 months from the baseline measure. The difference in PAM® score from time 1 to time 2 is the change score.

Numerator Instructions:
- A "passing" score = average net 3 point PAM® score increase in a 4 to 12 month period.
- An "excellent" score = average net 6 point PAM® score increase in a 4 to 12 month period.
- Either "passing" or "excellent" meets performance for this measure.
- If multiple PAM® scores available: most recent = follow-up; earliest within 4-12 months prior = baseline.

SUBMISSION CRITERIA 3 – NET INCREASE IN PAM® SCORE OF AT LEAST 6 POINTS:
Percentage of eligible patients who achieved a net increase in PAM® score of at least 6 points in a 4 to 12 month period (excellent).

Definition:
Patient Activation Measure-Performance Measure (PAM®-PM) requires that PAM® be measured at two points in time with the second measure occurring within 4 to 12 months from the baseline measure. The difference in PAM® score from time 1 to time 2 is the change score.

Numerator Instructions:
- A "passing" score = average net 3 point PAM® score increase in a 4 to 12 month period.
- An "excellent" score = average net 6 point PAM® score increase in a 4 to 12 month period.
- Either "passing" or "excellent" meets performance for this measure.
- If multiple PAM® scores available: most recent = follow-up; earliest within 4-12 months prior = baseline.

KEY TAKEAWAYS:
1. Submission Criteria 1: Requires two PAM® scores (baseline + follow-up) within 4-12 months
2. Submission Criteria 2: Requires net increase of ? 3 points (passing)
3. Submission Criteria 3: Requires net increase of ? 6 points (excellent)
4. Follow-up PAM® score must always occur during the current performance period
5. Baseline PAM® score can be from current OR prior performance period
6. PAM® scores range from 0-100, converted to Levels 1-4 (Level 4 = highest activation)
7. Extreme straight line responses or excessive missing responses = exception

PAM® MEASURE – NUMERATOR OPTIONS – ALL 3 SUBMISSION CRITERIA:

SUBMISSION CRITERIA 1 – TWO PAM® SCORES 6 TO 12 MONTHS APART:
- M1345: Performance Met – Patients who had a baseline PAM® score and a second score within 4 to 12 months of baseline PAM® score
- M1343: Denominator Exception – Patients who are at PAM® Level 4 at baseline OR patients flagged with extreme straight line response sets on the PAM® OR with excessive missing responses
- M1385: Denominator Exception – Documentation of patient reasons for patients who were not seen for the second PAM® survey (e.g., less than four months between baseline PAM® assessment and follow-up)
- M1344: Performance Not Met – Patients who did not have a baseline PAM® score and/or a second score within 4 to 12 months of baseline PAM® score

SUBMISSION CRITERIA 2 – NET INCREASE IN PAM® SCORE OF AT LEAST 3 POINTS:
- M1347: Performance Met – Patients who achieved a net increase in PAM® score of at least 3 points in a 4 to 12 month period (passing)
- M1349: Performance Not Met – Patients who did not have a net increase in PAM® score of at least 3 points within a 4 to 12 month period

SUBMISSION CRITERIA 3 – NET INCREASE IN PAM® SCORE OF AT LEAST 6 POINTS:
- M1348: Performance Met – Patients who achieved a net increase in PAM® score of at least 6 points in a 4 to 12 month period (excellent)
- M1346: Performance Not Met – Patients who did not have a net increase in PAM® score of at least 6 points within a 4 to 12 month period

The Patient Activation Measure (PAM®) assesses an individual’s ability to manage their own health and health care. The measure is not disease specific; it has been successfully used with a wide variety of chronic conditions, as well as with people with no conditions. The PAM® is predictive of most health outcomes, including such diverse outcomes as how a patient fares after orthopedic surgery; remission of depression over time; the likelihood of hospital re-admission or ambulatory care sensitive (ACS) utilization; the trajectory of a chronic disease over time; and even the likelihood of a new chronic disease diagnosis in the coming year. The PAM® surveys the knowledge, skill, and confidence necessary for self-management on a 0-100-point scale that can be broken down into 4 levels from low activation to high activation. The 13 (or 10) item survey has strong measurement properties and is predictive of most health behaviors and many clinical outcomes. PAM® scores are also predictive of health care costs, with lower scores predictive of higher costs.

The PAM® is in use both in the US and internationally in research (including more than 800 peer-reviewed journal articles) as well as clinical settings. It has been translated into more than 30 languages. Because researchers all over the world use PAM®, we have been able to validate the instrument with people of different racial and ethnic backgrounds, and with people from different socio-economic levels. The measure has been shown to be valid and reliable in different clinical settings and under different payment models.

A performance measure assessing average changes in PAM® scores has been endorsed by CBE (CBE#2483). The Patient Activation Measure-Performance Measure, the PAM®-PM, requires that PAM® be measured at two points in time. The difference in PAM® score from time 1 to time 2, or the change score is the PAM®-PM. This measure, as well as the PAM® survey, is used in a number of federal quality and payment programs.

While there are a few other measures that seek to assess patient engagement and activation, they do not possess the strong measurement properties of PAM® and do not have the depth of research supporting their validity and reliability. PAM® is the only measure of self-management capability endorsed by CBE to measure performance. While PAM® is built upon a true equal interval scale, as is the case with measures in the natural sciences (e.g. temperature, weight, HbA1c, blood pressure), competing measures of patient engagement utilize ordinal measurement (a lower form of measurement), that lacks the precision and consistency of interval level measurement Because of these strong measurement properties, researchers from all over the world chose to utilize the PAM® when assessing activation or self-management ability in their studies.