2026 MIPS Measure #222: Functional Status Change for Patients with Elbow, Wrist or Hand Impairments

A patient-reported outcome measure (PROM) of risk-adjusted change in functional status (FS) for patients 14 years+ with elbow, wrist, or hand impairments. The change in FS is assessed using the FOTO Elbow/Wrist/Hand FS PROM. The measure is adjusted to patient characteristics known to be associated with FS outcomes (risk adjusted) and used as a performance measure at the patient, individual clinician, and clinic levels to assess quality.

This outcome measure is to be submitted once per Treatment Episode for all patients with a functional deficit related to the elbow, wrist, or hand. This is an outcome measure and its calculation requires submitting of the patient’s FS PROM score, at a minimum, at the start (Initial Evaluation or Intake) and again at the conclusion (Discharge) of a Treatment Episode. The Initial Evaluation score is recorded during the first treatment encounter, and the Discharge score is recorded at or near the conclusion of the final treatment encounter. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians providing treatment for functional elbow, wrist, or hand deficits will submit this measure.

Definitions:
Functional Deficit – Limitation or impairment of physical abilities/function resulting in evaluation and inclusion in a treatment plan of care.

Treatment Episode – A “Treatment Episode” is defined as beginning with an Initial Evaluation for a functional elbow, wrist, or hand deficit, progressing through treatment without interruption (for example, a hospitalization or surgical intervention), and ending with Discharge, signifying that the treatment has been completed. A patient currently under clinical care for an elbow, wrist, or hand deficit remains in a single “Treatment Episode” until the Discharge is conducted and documented by the MIPS eligible clinician.

Initial Evaluation – An “Initial Evaluation” is the first encounter for a functional deficit involving the elbow, wrist, or hand and includes an evaluation (CPT 97161, 97162, 97163, 97165, 97166, 97167, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 98940, 98941, 98942, 98943*, 99304, 99305, or 99306), or an “Initial Evaluation” Status M-code (M1135). A patient presenting with an elbow, wrist, or hand impairment, who has had an interruption of a Treatment Episode for the same functional knee deficit secondary to an appropriate reason like hospitalization or surgical intervention, is an “Initial Evaluation”.

Discharge – “Discharge” is accompanied by a treatment finalization and evaluation completion M-Code (M1014) for identifying the close of a Treatment Episode for the same elbow, wrist, or hand deficit identified at the Initial Evaluation and documented by a “Discharge” report by the MIPS eligible clinician. An interruption in clinical care for an appropriate reason like hospitalization or surgical intervention requires a discharge from the current Treatment Episode.

Encounter – A visit between the patient and the provider for the purpose of assessing and/or improving a functional deficit.

Patient Reported – The patient directly provides answers to the FS PROM items. If the patient cannot reliably respond independently (e.g. in the presence of cognitive deficits), a suitable proxy may provide answers.

The Elbow/Wrist/Hand FS PROM score – The “Elbow/Wrist/Hand FS PROM score” may be achieved using one of three forms: the FOTO Elbow/Wrist/Hand FS PROM computer adaptive test, the FOTO Elbow/Wrist/Hand FS PROM short form, or an alternative PROM score that is cross-walked to the FOTO Elbow/Wrist/Hand FS PROM, using a cross-walk form developed by the measure steward. Computer adaptive test (CAT) is recommended to achieve best balance between reduced patient burden and score precision. At least one cross-walk form has been developed by the measure steward and meets scientific standards to successfully link a construct-equivalent PROM using advanced psychometric equating methods.

For more information about the Elbow/Wrist/Hand FS PROM score forms and to access the components that are available free of charge for use with this MIPS quality measure [e.g., patient-reported outcome measure(s), cross-walking, risk adjustment], visit Public Access to FOTO Measures.

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.

All patients 14 years and older with elbow, wrist, or hand impairments who have initiated a Treatment Episode.

DENOMINATOR NOTE: *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 should be counted in the denominator population for MIPS CQMs.

All patients aged ?14 on date of Initial Evaluation

AND

Patient encounter during the performance period identifying evaluation (CPT or M-code): 97161, 97162, 97163, 97165, 97166, 97167, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 98940, 98941, 98942, 98943*, 99304, 99305, 99306, M1135, M1426

AND

With an elbow, wrist, or hand impairment and/or diagnosis pertaining to a functional deficit affecting the elbow, wrist, or hand (ICD-10-CM): M05.121, M05.122, M05.131, M05.132, M05.141, M05.142, M05.221, M05.222, M05.231, M05.232, M05.241, M05.242, M05.321, M05.322, M05.331, M05.332, M05.341, M05.342, M05.421, M05.422, M05.431, M05.432, M05.441, M05.442, M05.521, M05.522, M05.531, M05.532, M05.541, M05.542, M05.621, M05.622, M05.631, M05.632, M05.641, M05.642, M05.721, M05.722, M05.731, M05.732, M05.741, M05.742, M05.821, M05.822, M05.831, M05.832, M05.841, M05.842, M06.021, M06.022, M06.031, M06.032, M06.041, M06.042, M06.221, M06.222, M06.231, M06.232, M06.241, M06.242, M06.321, M06.322, M06.331, M06.332, M06.341, M06.342, M06.821, M06.822, M06.831, M06.832, M06.841, M06.842, M08.021, M08.022, M08.031, M08.032, M08.041, M08.042, M08.221, M08.222, M08.231, M08.232, M08.241, M08.242, M08.421, M08.422, M08.431, M08.432, M08.441, M08.442, M08.821, M08.822, M08.831, M08.832, M08.841, M08.842, M08.921, M08.922, M08.931, M08.932, M08.941, M08.942, M11.021, M11.022, M11.031, M11.032, M11.041, M11.042, M11.121, M11.122, M11.131, M11.132, M11.141, M11.142, M11.221, M11.222, M11.231, M11.232, M11.241, M11.242, M11.821, M11.822, M11.831, M11.832, M11.841, M11.842, M12.521, M12.522, M12.531, M12.532, M12.541, M12.542, M12.821, M12.822, M12.831, M12.832, M12.841, M12.842, M13.121, M13.122, M13.131, M13.132, M13.141, M13.142, M13.821, M13.822, M13.831, M13.832, M13.841, M13.842, M14.621, M14.622, M14.631, M14.632, M14.641, M14.642, M14.821, M14.822, M14.831, M14.832, M14.841, M14.842, M18.0, M18.11, M18.12, M18.2, M18.31, M18.32, M18.4, M18.51, M18.52, M19.021, M19.022, M19.031, M19.032, M19.041, M19.042, M19.121, M19.122, M19.131, M19.132, M19.141, M19.142, M19.221, M19.222, M19.231, M19.232, M19.241, M19.242, M20.001, M20.002, M20.011, M20.012, M20.021, M20.022, M20.031, M20.032, M20.091, M20.092, M21.021, M21.022, M21.221, M21.222, M21.231, M21.232, M21.241, M21.242, M21.331, M21.332, M21.511, M21.512, M21.521, M21.522, M21.831, M21.832, M21.931, M21.932, M21.941, M21.942, M24.021, M24.022, M24.031, M24.032, M24.041, M24.042, M24.121, M24.122, M24.131, M24.132, M24.141, M24.142, M24.221, M24.222, M24.231, M24.232, M24.241, M24.242, M24.421, M24.422, M24.431, M24.432, M24.441, M24.442, M24.444, M24.445, M24.521, M24.522, M24.531, M24.532, M24.541, M24.542, M24.621, M24.622, M24.631, M24.632, M24.641, M24.642, M24.821, M24.822, M24.831, M24.832, M24.841, M24.842, M25.021, M25.022, M25.031, M25.032, M25.041, M25.042, M25.221, M25.222, M25.231, M25.232, M25.241, M25.242, M25.321, M25.322, M25.331, M25.332, M25.341, M25.342, M25.421, M25.422, M25.431, M25.432, M25.441, M25.442, M25.521, M25.522, M25.531, M25.532, M25.541, M25.542, M25.621, M25.622, M25.631, M25.632, M25.641, M25.642, M25.721, M25.722, M25.731, M25.732, M25.741, M25.742, M25.821, M25.822, M25.831, M25.832, M25.841, M25.842, M61.031, M61.032, M61.041, M61.042, M61.131, M61.132, M61.141, M61.142, M61.144, M61.145, M61.231, M61.232, M61.241, M61.242, M61.331, M61.332, M61.341, M61.342, M61.431, M61.432, M61.441, M61.442, M62.031, M62.032, M62.041, M62.042, M62.131, M62.132, M62.141, M62.142, M62.231, M62.232, M62.241, M62.242, M62.431, M62.432, M62.441, M62.442, M62.531, M62.532, M62.541, M62.542, M63.831, M63.832, M63.841, M63.842, M65.231, M65.232, M65.241, M65.242, M65.311, M65.312, M65.321, M65.322, M65.331, M65.332, M65.341, M65.342, M65.351, M65.352, M65.4, M65.831, M65.832, M65.841, M65.842, M66.121, M66.122, M66.131, M66.132, M66.141, M66.142, M66.144, M66.145, M66.231, M66.232, M66.241, M66.242, M66.331, M66.332, M66.341, M66.342, M66.831, M66.832, M66.841, M66.842, M67.231, M67.232, M67.241, M67.242, M67.321, M67.322, M67.331, M67.332, M67.341, M67.342, M67.421, M67.422, M67.431, M67.432, M67.441, M67.442, M67.821, M67.822, M67.823, M67.824, M67.831, M67.832, M67.833, M67.834, M67.841, M67.842, M67.843, M67.844, M67.931, M67.932, M67.941, M67.942, M70.031, M70.032, M70.041, M70.042, M70.11, M70.12, M70.21, M70.22, M70.31, M70.32, M70.831, M70.832, M70.841, M70.842, M70.931, M70.932, M70.941, M70.942, M71.021, M71.321, M71.322, M71.331, M71.332, M71.341, M71.342, M71.421, M71.422, M71.431, M71.432, M71.441, M71.442, M71.521, M71.522, M71.531, M71.532, M71.541, M71.542, M71.821, M71.822, M71.831, M71.832, M71.841, M71.842, M72.0, M77.01, M77.02, M77.11, M77.12, M77.21, M77.22, M79.631, M79.632, M79.641, M79.642, M79.644, M79.645, M84.331D, M84.331G, M84.331K, M84.331P, M84.331S, M84.332D, M84.332G, M84.332K, M84.332P, M84.332S, M84.333D, M84.333G, M84.333K, M84.333P, M84.333S, M84.334D, M84.334G, M84.334K, M84.334P, M84.334S, M84.341D, M84.341G, M84.341K, M84.341P, M84.341S, M84.342D, M84.342G, M84.342K, M84.342P, M84.342S, M84.344D, M84.344G, M84.344K, M84.344P, M84.344S, M84.345D, M84.345G, M84.345K, M84.345P, M84.345S, M92.11, M92.12, M92.201, M92.202, M92.211, M92.212, M92.221, M92.222, M92.291, M92.292, M93.221, M93.222, M93.231, M93.232, M93.241, M93.242, M93.831, M93.832, M93.841, M93.842, M93.931, M93.932, M93.941, M93.942, M94.221, M94.222, M94.231, M94.232, M94.241, M94.242, M94.8X3, M94.8X4, M96.631, M96.632, M97.41XA, M97.41XD, M97.41XS, M97.42XA, M97.42XD, M97.42XS, S42.401D, S42.401G, S42.401K, S42.401P, S42.401S, S42.402D, S42.402G, S42.402K, S42.402P, S42.402S, S42.411D, S42.411G, S42.411K, S42.411P, S42.411S, S42.412D, S42.412G, S42.412K, S42.412P, S42.412S, S42.414D, S42.414G, S42.414K, S42.414P, S42.414S, S42.415D, S42.415G, S42.415K, S42.415P, S42.415S, S42.421D, S42.421G, S42.421K, S42.421P, S42.421S, S42.422D, S42.422G, S42.422K, S42.422P, S42.422S, S42.424D, S42.424G, S42.424K, S42.424P, S42.424S, S42.425D, S42.425G, S42.425K, S42.425P, S42.425S, S42.431D, S42.431G, S42.431K, S42.431P, S42.431S, S42.432D, S42.432G, S42.432K, S42.432P, S42.432S, S42.434D, S42.434G, S42.434K, S42.434P, S42.434S, S42.435D, S42.435G, S42.435K, S42.435P, S42.435S, S42.441D, S42.441G, S42.441K, S42.441P, S42.441S, S42.442D, S42.442G, S42.442K, S42.442P, S42.442S, S42.444D, S42.444G, S42.444K, S42.444P, S42.444S, S42.445D, S42.445G, S42.445K, S42.445P, S42.445S, S42.447D, S42.447G, S42.447K, S42.447P, S42.447S, S42.448D, S42.448G, S42.448K, S42.448P, S42.448S, S42.451D, S42.451G, S42.451K, S42.451P, S42.451S, S42.452D, S42.452G, S42.452K, S42.452P, S42.452S, S42.454D, S42.454G, S42.454K, S42.454P, S42.454S, S42.455D, S42.455G, S42.455K, S42.455P, S42.455S, S42.461D, S42.461G, S42.461K, S42.461P, S42.461S, S42.462D, S42.462G, S42.462K, S42.462P, S42.462S, S42.464D, S42.464G, S42.464K, S42.464P, S42.464S, S42.465D, S42.465G, S42.465K, S42.465P, S42.465S, S42.471D, S42.471G, S42.471K, S42.471P, S42.471S, S42.472D, S42.472G, S42.472K, S42.472P, S42.472S, S42.474D, S42.474G, S42.474K, S42.474P, S42.474S, S42.475D, S42.475G, S42.475K, S42.475P, S42.475S, S42.481G, S42.481K, S42.481P, S42.481S, S42.482G, S42.482K, S42.482P, S42.482S, S42.491D, S42.491G, S42.491K, S42.491P, S42.491S, S42.492D, S42.492G, S42.492K, S42.492P, S42.492S, S42.494D, S42.494G, S42.494K, S42.494P, S42.494S, S42.495D, S42.495G, S42.495K, S42.495P, S42.495S, S49.101D, S49.101G, S49.101K, S49.101P, S49.101S, S49.102D, S49.102G, S49.102K, S49.102P, S49.102S, S49.111D, S49.111G, S49.111K, S49.111P, S49.111S, S49.112D, S49.112G, S49.112K, S49.112P, S49.112S, S49.121D, S49.121G, S49.121K, S49.121P, S49.121S, S49.122D, S49.122G, S49.122K, S49.122P, S49.122S, S49.131G, S49.131K, S49.131P, S49.131S, S49.132D, S49.132G, S49.132K, S49.132P, S49.132S, S49.141G, S49.141K, S49.141P, S49.141S, S49.142D, S49.142G, S49.142K, S49.142P, S49.142S, S49.191D, S49.191G, S49.191K, S49.191P, S49.191S, S49.192D, S49.192G, S49.192K, S49.192P, S49.192S, S50.01XA, S50.01XD, S50.01XS, S50.02XA, S50.02XD, S50.02XS, S50.11XA, S50.11XD, S50.11XS, S50.12XA, S50.12XD, S50.12XS, S52.001D, S52.001E, S52.001F, S52.001G, S52.001H, S52.001J, S52.001K, S52.001M, S52.001N, S52.001P, S52.001Q, S52.001R, S52.001S, S52.002D, S52.002E, S52.002F, S52.002G, S52.002H, S52.002J, S52.002K, S52.002M, S52.002N, S52.002P, S52.002Q, S52.002R, S52.002S, S52.011D, S52.011G, S52.011K, S52.011P, S52.011S, S52.012D, S52.012G, S52.012K, S52.012P, S52.012S, S52.021D, S52.021E, S52.021F, S52.021G, S52.021H, S52.021J, S52.021K, S52.021M, S52.021N, S52.021P, S52.021Q, S52.021R, S52.021S, S52.022D, S52.022E, S52.022F, S52.022G, S52.022H, S52.022J, S52.022K, S52.022M, S52.022N, S52.022P, S52.022Q, S52.022R, S52.022S, S52.024D, S52.024E, S52.024F, S52.024G, S52.024H, S52.024J, S52.024K, S52.024M, S52.024N, S52.024P, S52.024Q, S52.024R, S52.024S, S52.025D, S52.025E, S52.025F, S52.025G, S52.025H, S52.025J, S52.025K, S52.025M, S52.025N, S52.025P, S52.025Q, S52.025R, S52.025S, S52.031D, S52.031E, S52.031F, S52.031G, S52.031H, S52.031J, S52.031K, S52.031M, S52.031N, S52.031P, S52.031Q, S52.031R, S52.031S, S52.032D, S52.032E, S52.032F, S52.032G, S52.032H, S52.032J, S52.032K, S52.032M, S52.032N, S52.032P, S52.032Q, S52.032R, S52.032S, S52.034D, S52.034E, S52.034F, 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