2026 MIPS Measure #282: Dementia: Functional Status Assessment

Percentage of patients with dementia for whom an assessment of functional status was performed at least once in the last 12 months.

This measure is to be submitted a minimum of once per performance period for patients with a diagnosis of dementia seen during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

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 with a diagnosis of dementia

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 regardless of age

AND

Diagnosis for dementia (ICD-10-CM): A52.17, A81.00, A81.01, A81.89, F01.50, F01.511, F01.518, F01.52, F01.53, F01.54, F01.A0, F01.A11, F01.A18, F01.A2, F01.A3, F01.A4, F01.B0, F01.B11, F01.B18, F01.B2, F01.B3, F01.B4, F01.C0, F01.C11, F01.C18, F01.C2, F01.C3, F01.C4, F02.80, F02.811, F02.818, F02.82, F02.83, F02.84, F02.A0, F02.A11, F02.A18, F02.A2, F02.A3, F02.A4, F02.B0, F02.B11, F02.B18, F02.B2, F02.B3, F02.B4, F02.C0, F02.C11, F02.C18, F02.C2, F02.C3, F02.C4, F03.90, F03.911, F03.918, F03.92, F03.93, F03.94, F03.A0, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B0, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C0, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, F10.27, G30.0, G30.1, G30.8, G30.9, G31.01, G31.09, G31.83, G31.85, G31.89, G94

AND

Patient encounter during the performance period (CPT or HCPCS): 78811, 78814, 90791, 90792, 90832, 90834, 90837, 92522, 92523, 92610, 92611, 92612, 92616, 96105, 96112, 96116, 96125, 96130, 96132, 96136, 96138, 96146, 96156, 96158, 96164, 96167, 96170*, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99242*, 99243*, 99244*, 99245*, 99252*, 99253*, 99254*, 99255*, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99424, 99426, 99487, 99490, 99491, 99497, A9586, A9601, Q9982, Q9983

Patients for whom an assessment of functional status was performed at least once in the last 12 months

Assessment of functional status – Functional status is assessed by use of a validated tool, direct assessment of the patient, or by querying a knowledgeable informant. A direct “assessment of functional status” includes an evaluation of the patient’s ability to perform instrumental activities of daily living (IADL) and basic activities of daily living (ADL).

Numerator Instructions:
To meet this measure providers must assess BOTH IADL and ADL performance.

1. IADL Assessment (users must meet one of the two below bullets to meet IADL assessment component)

To meet the measure’s IADL component using a validated tool, providers must use one of the following tools:
Lawton Instrumental Activities of Daily Living Scale
Bristol Activities of Daily Living Scale
Katz Index of Independence in Activities of Daily Living
Functional Activities Questionnaire
Functional Independence Measure Instrument
To meet the measure’s IADL component using a direct assessment, providers must document 3 out of the following 5 domains.
Cleaning or hobbies,
Money management,
Medication management,
Transportation, and
Cooking or communication
2. ADL Assessment (users must meet one of the two below bullets to meet ADL assessment component)

To meet the measure’s ADL component using a validated tool, providers must use either:
Barthel ADL Index
Bristol Activities of Daily Living Scale
To meet the measure’s ADL component using a direct assessment, providers must document 3 out of the following 7 domains.
Grooming,
Bathing,
Dressing,
Eating,
Toileting,
Gait, and
Transferring.
NUMERATOR NOTE: The 12 month look back period is defined as 12 months from the date of the denominator eligible encounter. Denominator Exception(s) are determined on the date of the denominator eligible encounter. Documentation of advanced stage dementia and caregiver knowledge is limited would meet the measure exception criteria.

Performance Met: Functional status performed once in the last 12 months (G9916)

OR

Denominator Exception: Documentation of advanced stage dementia and caregiver knowledge is limited (G9917)

OR

Performance Not Met: Functional status not performed, reason not otherwise specified (G9918)

Maintaining or increasing physical functioning levels is a desired outcome. This is key to maintaining quality of life and reducing caregiver burden. This requires regular assessment of function in multiple domains.

In routine practice, persons with dementia may not be assessed regularly for changes in their ability to perform both basic and instrumental activities of daily living. (Black BS, Johnston D, Rabins PV, et al. Unmet Needs of Community-Residing Persons with Dementia and Their Informal Caregivers: Findings from the MIND at Home Study. J Am Geriatr Soc 2013;61(12):2087-2095.) Frequent and comprehensive assessments will allow health care providers to track these changes and to make timely interventions aimed at preserving function or mitigating disability.

When planning interventions to improve or maintain function, it is important to consider a broad range of causes of functional impairment, including impaired cognition.

Perform regular, comprehensive person-centered assessments and timely interim assessments. Assessments, conducted at least every 6 months, should prioritize issues that help the person with dementia to live fully. These include assessments of the individual and care partner’s relationships and subjective experience and assessment of cognition, behavior, and function, using reliable and valid tools. Assessment is ongoing and dynamic, combining nomothetic (norm-based) and idiographic (individualized) approaches. (Molony SL, Kolanowski A, Van Haitsma K, et al. Person-Centered Assessment and Care Planning. The Gerontologist. 2018; 58(1):S32-S47.)