2026 MIPS Measure #113: Colorectal Cancer Screening

Percentage of patients 45-75 years of age who had appropriate screening for colorectal cancer.

This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. There is no diagnosis associated with this measure. Performance for this measure is not limited to 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 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. This measure specification is only available for MIPS Value Pathways (MVP) reporting and is not available for traditional MIPS reporting. 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.

Patients 45-75 years of age with a visit during the measurement period

DENOMINATOR NOTE: To assess the age for exclusions, the patient’s age on the date of the encounter should be used

*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.

COLORECTAL CANCER SCREENING (CRC) MEASURE – SUMMARY:

INCLUSION (DENOMINATOR):
- Age: 45 to 75 years on date of encounter
- Encounter during performance period using eligible CPT/HCPCS codes (see full list)

DENOMINATOR EXCLUSIONS (EXCLUDE FROM MEASURE IF ANY):
1. G9711 – Diagnosis or past history of total colectomy OR colorectal cancer
2. G9710 – Hospice services anytime during measurement period
3. G9993 – Palliative care services anytime during measurement period
4. G9901 – Age ?66 in Institutional SNP OR residing in long-term care (POS 32,33,34,54,56) for >90 consecutive days during measurement period
5. G2100 – Age ?66 with frailty (claim/encounter) AND dementia medication dispensed during measurement period OR prior year
6. G2101 – Age ?66 with frailty (claim/encounter) AND advanced illness diagnosis during measurement period OR prior year

FRAILTY CODES (for G2100 & G2101):
- HCPCS/CPT: 99504, 99509, E0100–E0171, E0250–E0304, E0424–E0472, E0561–E0562, E1130–E1298, G0162, G0299–G0300, G0493–G0494, S0271, S0311, S9123–S9124, T1000–T1031
- ICD-10-CM: L89.000–L89.96 (pressure ulcers), M62.50, M62.81, M62.84, R26.2, R26.89, R26.9, R29.6, R53.1, R53.81, R54, R62.7, R63.4, R63.6, R64, W01.0XXA–W19.XXXS (falls), Y92.199, Z59.3, Z73.6, Z74.01–Z74.9, Z91.81, Z99.11, Z99.3, Z99.81, Z99.89

ADVANCED ILLNESS CODES (for G2101):
- ICD-10-CM: A81.00–A81.09 (Prion disease), C25.0–C25.9 (Pancreatic cancer), C71.0–C71.9 (Brain cancer), C77.0–C79.9 (Metastatic cancer), C91.00–C94.32 (Leukemias), F01.50–F04 (Dementia/Alzheimer's with various complications), F10.27, F10.96–F10.97 (Alcohol-related), G10 (Huntington's), G12.21, G20.A1–G20.C (Parkinson's), G30.0–G31.83 (Alzheimer's/other degeneration), G35.A–G35.D (Multiple sclerosis), I09.81, I11.0, I12.0, I13.0–I13.2 (Hypertensive kidney disease), I50.1–I50.9 (Heart failure), J43.0–J43.9 (Emphysema), J68.4, J84.10–J84.178 (Interstitial lung disease), J96.10–J96.92 (Respiratory failure), J98.2–J98.3 (Interstitial emphysema/compensatory emphysema), K70.10–K74.69 (Liver disease/cirrhosis), N18.5–N18.6 (CKD stage 4-5)

DEMENTIA EXCLUSION MEDICATIONS (for G2100):
- Cholinesterase inhibitors: Donepezil, Galantamine, Rivastigmine
- Miscellaneous CNS agents: Memantine
- Dementia combinations: Donepezil-memantine

KEY TAKEAWAY:
Patient qualifies for measure if age 45-75 + eligible visit – EXCLUDE if any of G9711 (total colectomy/colorectal cancer), G9710 (hospice), G9993 (palliative), G9901 (long-term care >90d), G2100 (frailty + dementia meds), G2101 (frailty + advanced illness), or POS for long-term care exclusions.

Patients with one or more screenings for colorectal cancer. Appropriate screenings are defined by any one of the following criteria:

Fecal occult blood test (FOBT) during the measurement period
Flexible sigmoidoscopy during the measurement period or the four years prior to the measurement period
Colonoscopy during the measurement period or the nine years prior to the measurement period
Computed tomography (CT) colonography during the measurement period or the four years prior to the measurement period.
Stool DNA (sDNA) with FIT test during the measurement period or the two years prior to the measurement period.

Definition:
Reviewed – to meet the quality action, there must be documentation in the medical record that the clinician reviewed the colorectal screening report. The colorectal screening report may also be provided by the patient for the clinician’s review during the visit and should be documented in the medical record.

Numerator Instructions:
Do not count digital rectal exam (DRE)-acquired fecal occult blood tests (FOBTs) performed in an office setting or performed on a sample collected via DRE.

Please note the measure may include screenings performed outside the age range of patients referenced in the initial population. Screenings that occur prior to the measurement period are valid to meet measure criteria.

NUMERATOR NOTE: Patient reported procedures and diagnostic studies, when recorded in the medical record, are acceptable for meeting the numerator. While reviewing the results with the patient is not required for the purposes of reporting this measure, it is nonetheless best practice.

Performance Met: Colorectal cancer screening results documented and reviewed (3017F)

OR

Performance Not Met: Colorectal cancer screening results were not documented and reviewed, reason not otherwise specified (3017F with 8P)

Colorectal cancer represents eight percent of all new cancer cases in the United States. In 2020, there are an estimated 147,950 new cases of colorectal cancer and an estimated 53,200 deaths attributed to it. According to the National Cancer Institute, about 4.2 percent of men and women will be diagnosed with colorectal cancer at some point during their lifetimes. For most adults, older age is the most important risk factor for colorectal cancer, although being male and black are also associated with higher incidence and mortality. Colorectal cancer is most frequently diagnosed among people 65 to 74 years old (National Cancer Institute, 2020).

Screening can be effective for finding precancerous lesions (polyps) that could later become malignant, and for detecting early cancers that can be more easily and effectively treated. Precancerous polyps usually take about 10 to 15 years to develop into colorectal cancer, and most can be found and removed before turning into cancer. The fiveyear relative survival rate for people whose colorectal cancer is found in the early stage before it has spread is about 90 percent (American Cancer Society, 2020).

The U.S. Preventive Services Task Force (2021) recommends screening for colorectal cancer in adults aged 45 to 49 years. This is a Grade B recommendation (U.S. Preventive Services Task Force, 2021).

The U.S. Preventive Services Task Force (2021) recommends screening for colorectal cancer in adults aged 50 to 75 years. This is a Grade A recommendation (U.S. Preventive Services Task Force, 2021).

Appropriate screenings are defined by any one of the following:

Colonoscopy (every 10 years)
Flexible sigmoidoscopy (every 5 years)
Fecal occult blood test (annually)
Stool DNA (sDNA) with FIT test (every 3 years)
Computed tomographic colonography (every 5 years)