2026 MIPS Measure #405: Appropriate Follow-up Imaging for Incidental Abdominal Lesions

Percentage of final reports for imaging studies for patients aged 18 years and older with one or more of the following noted incidentally with a specific recommendation for no follow�up imaging recommended based on radiological findings:
• Cystic renal lesion that is simple appearing* (Bosniak I or II)
• Adrenal lesion less than or equal to 1.0 cm
• Adrenal lesion greater than 1.0 cm but less than or equal to 4.0 cm classified as likely benign or diagnostic benign by unenhanced CT or washout protocol CT, or MRI with in- and opposed-phase sequences or other equivalent institutional imaging protocols

This measure is to be submitted each time a patient undergoes an imaging study with an incidental abdominal lesion finding during the performance period. There is no diagnosis associated with this measure. It is anticipated that Meritbased Incentive Payment System (MIPS) eligible clinicians who provide the professional component of diagnostic imaging studies will submit this measure.

All final reports for imaging studies for patients aged 18 years and older with one or more of the following incidentally noted:

Cystic renal lesion that is simple appearing (Bosniak I or II)
or
Adrenal lesion less than or equal to 1.0 cm
or
Adrenal lesion greater than 1.0 cm but less than or equal to 4.0 cm classified as likely benign or diagnostic benign by unenhanced CT or washout protocol CT, or MRI with in- and opposed-phase sequences or other equivalent institutional imaging protocols
Definition:
*Simple-appearing criteria:

Incidental renal mass on non-contrast enhanced abdominal CT that does not contain fat, is homogenous in appearance, -10-20 HU or ?70 HU. (American College of Radiology (ACR), 2017)
Incidental renal mass on contrast-enhanced abdominal CT that does not contain fat, is homogenous in appearance, -10-20 HU. (American College of Radiology (ACR), 2017)

DENOMINATOR NOTE: When reporting this measure, masses and lesions that do not meet all the criteria for “no further work-up” as provided in Management of the Incidental Renal Mass on CT: A White Paper of the ACR Incidental Findings Committee or the Management of the Incidental Adrenal Mass on CT: A White Paper of the ACR Incidental Findings Committee should not be considered in the context or intent of this measure. However, generally accepted radiology practices should be followed with respect to communication and management of any characteristically benign findings. A measure performance goal of 100% should not substitute for clinical judgment in individual cases.

Patients aged ? 18 years on date of encounter

AND

Patient procedure during the performance period (CPT): 71250, 71260, 71270, 71271, 71275, 71555, 72131, 72191, 72192, 72193, 72194, 72195, 72196, 72197, 72198, 74150, 74160, 74170, 74176, 74177, 74178, 74181, 74182, 74183

AND

Incidental finding: Cystic renal lesion that is simple appearing (Bosniak I or II), or Adrenal lesion less than or equal to 1.0 cm or Adrenal lesion greater than 1.0 cm but less than or equal to 4.0 cm classified as likely benign by unenhanced CT or washout protocol CT, or MRI with in- and opposed-phase sequences or other equivalent institutional imaging protocols: G9547

Final reports for imaging studies that include a description of incidental cystic renal lesion or adrenal lesion stating followup imaging is not recommended

Numerator Instructions:
A short note can be made in the final report, such as:

“No follow-up imaging is recommended as incidental lesions are likely benign” or
“No follow-up imaging is recommended per consensus recommendations based on imaging criteria. Further lab evaluation could be pursued based on clinical findings.”

Performance Met: Final reports for imaging studies stating no follow-up imaging is recommended (G9548)

OR

Denominator Exception: Documentation of medical reason(s) that follow-up imaging is indicated (e.g., patient has lymphadenopathy, signs of metastasis or an active diagnosis or history of cancer, and other medical reason(s)) (G9549)

OR

Performance Not Met: Final reports for imaging studies with follow-up imaging recommended, or final reports that do not include a specific recommendation of no follow-up (G9550)

Incidental renal and adrenal lesions are commonly found during imaging studies where the abdomen can be viewed, with most of the findings being benign. Given the low rate of malignancy, unnecessary follow-up procedures are costly and present a significant burden to patients. To avoid excessive testing and costs, follow-up is not recommended for these small lesions.