2026 MIPS Measure #126: Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy – Neurological Evaluation

Percentage of patients aged 18 years and older with a diagnosis of diabetes mellitus who had a neurological examination of their lower extremities within 12 months.

DIABETES FOOT & ANKLE CARE – NEUROLOGICAL EVALUATION & RISK CATEGORIZATION MEASURE – SUMMARY:

MEASURE PURPOSE:
Evaluate neurological status in patients with diabetes to assign risk category and guide appropriate foot/ankle care to prevent ulcerations, infections, and amputations. Submit at least once per performance period for patients with diabetes.

RISK CATEGORIZATION SYSTEM (TABLE 1):

Category 0 (Normal):
- Risk Profile: Normal
- Evaluation Frequency: Annual

Category 1 (Peripheral Neuropathy / LOPS):
- Risk Profile: Peripheral Neuropathy (LOPS)
- Evaluation Frequency: Semi-annual (every 6 months)

Category 2 (Neuropathy + Deformity + PAD):
- Risk Profile: Neuropathy, deformity, and/or PAD (Peripheral Artery Disease)
- Evaluation Frequency: Quarterly (every 3 months)

Category 3 (Previous Ulcer or Amputation):
- Risk Profile: Previous ulcer or amputation
- Evaluation Frequency: Monthly to quarterly (1-3 months)

KEY TAKEAWAYS:
1. All diabetic patients must have neurological status evaluated to assign a risk category.
2. Frequency of follow-up increases with higher risk:
- Normal ? Annual
- LOPS only ? Semi-annual
- Neuropathy + deformity/PAD ? Quarterly
- History of ulcer/amputation ? Monthly to quarterly
3. Appropriate risk-based follow-up reduces amputation rates.
4. Measure may be submitted by non-MD/DO MIPS eligible clinicians performing the quality actions.

DENOMINATOR (Inclusion):
- Patients with diabetes mellitus (diagnosis codes per measure specification)
- Seen during the performance period

NUMERATOR (Performance Met):
- Neurological evaluation performed AND risk category assigned per Table 1
- Appropriate follow-up plan documented based on assigned category

DENOMINATOR EXCLUSIONS:
- Refer to full measure specification (likely includes hospice, palliative care, frailty + dementia, long-term care, etc. similar to other diabetes measures)

ANTIBIOTIC MEDICATIONS:
- Not applicable to this measure (no antibiotic component)

All patients aged 18 years and older with a diagnosis of diabetes mellitus

Patients aged ? 18 years on date of encounter

AND

Diagnosis for diabetes on date of encounter (ICD-10-CM): E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.3211, E10.3212, E10.3213, E10.3219, E10.3291, E10.3292, E10.3293, E10.3299, E10.3311, E10.3312, E10.3313, E10.3319, E10.3391, E10.3392, E10.3393, E10.3399, E10.3411, E10.3412, E10.3413, E10.3419, E10.3491, E10.3492, E10.3493, E10.3499, E10.3511, E10.3512, E10.3513, E10.3519, E10.3521, E10.3522, E10.3523, E10.3529, E10.3531, E10.3532, E10.3533, E10.3539, E10.3541, E10.3542, E10.3543, E10.3549, E10.3551, E10.3552, E10.3553, E10.3559, E10.3591, E10.3592, E10.3593, E10.3599, E10.37X1, E10.37X2, E10.37X3, E10.37X9, E10.36, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E10.A0, E10.A1, E10.A2, E11.A, E11.00, E11.01, E11.10, E11.11, E11.21, E11.22, E11.29, E11.311, E11.319, E11.3211, E11.3212, E11.3213, E11.3219, E11.3291, E11.3292, E11.3293, E11.3299, E11.3311, E11.3312, E11.3313, E11.3319, E11.3391, E11.3392, E11.3393, E11.3399, E11.3411, E11.3412, E11.3413, E11.3419, E11.3491, E11.3492, E11.3493, E11.3499, E11.3511, E11.3512, E11.3513, E11.3519, E11.3521, E11.3522, E11.3523, E11.3529, E11.3531, E11.3532, E11.3533, E11.3539, E11.3541, E11.3542, E11.3543, E11.3549, E11.3551, E11.3552, E11.3553, E11.3559, E11.3591, E11.3592, E11.3593, E11.3599, E11.37X1, E11.37X2, E11.37X3, E11.37X9, E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9, E13.00, E13.01, E13.10, E13.11, E13.21, E13.22, E13.29, E13.311, E13.319, E13.3211, E13.3212, E13.3213, E13.3219, E13.3291, E13.3292, E13.3293, E13.3299, E13.3311, E13.3312, E13.3313, E13.3319, E13.3391, E13.3392, E13.3393, E13.3399, E13.3411, E13.3412, E13.3413, E13.3419, E13.3491, E13.3492, E13.3493, E13.3499, E13.3511, E13.3512, E13.3513, E13.3519, E13.3521, E13.3522, E13.3523, E13.3529, E13.3531, E13.3532, E13.3533, E13.3539, E13.3541, E13.3542, E13.3543, E13.3549, E13.3551, E13.3552, E13.3553, E13.3559, E13.3591, E13.3592, E13.3593, E13.3599, E13.37X1, E13.37X2, E13.37X3, E13.37X9, E13.36, E13.39, E13.40, E13.41, E13.42, E13.43, E13.44, E13.49, E13.51, E13.52, E13.59, E13.610, E13.618, E13.620, E13.621, E13.622, E13.628, E13.630, E13.638, E13.641, E13.649, E13.65, E13.69, E13.8, E13.9

AND

Patient encounter during the performance period (CPT): 11042, 11043, 11044, 11055, 11056, 11057, 11719, 11720, 11721, 11730, 11740, 97161, 97162, 97163, 97164, 97597, 97802, 97803, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350

WITHOUT

Encounters conducted via telehealth: M1426

AND NOT

DENOMINATOR EXCLUSION:

Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure, for example patient bilateral amputee; patient has condition that would not allow them to accurately respond to a neurological exam (dementia, Alzheimer’s, etc.); patient has previously documented diabetic peripheral neuropathy with loss of protective sensation: G2178

Patients who had a lower extremity neurological exam performed at least once within 12 months

Lower Extremity Neurological Exam – Consists of a documented evaluation of motor and sensory abilities and should include: 10-g monofilament plus testing any one of the following: vibration using 128-Hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold; however, the clinician should perform all necessary tests to make the proper evaluation.

NUMERATOR NOTE: To determine performance met, the lower extremity neurological exam could be performed and documented on the date of the denominator eligible encounter or within the 12- month lookback period from the date of the denominator eligible encounter.

Performance Met: Lower extremity neurological exam performed and documented (G8404)

OR

Denominator Exception: Clinician documented that patient had medical reason for not performing lower extremity neurological exam (G2179)

OR

Performance Not Met: Lower extremity neurological exam not performed (G8405)

Foot ulceration is the most common single precursor to lower extremity amputations among persons with diabetes. Treatment of infected foot wounds accounts for up to one-quarter of all inpatient hospital admissions for people with diabetes in the United States. Peripheral sensory neuropathy in the absence of perceived trauma is the primary factor leading to diabetic foot ulcerations. Approximately 45-60% of all diabetic ulcerations are purely neuropathic. Other forms of neuropathy may also play a role in foot ulcerations. Motor neuropathy resulting in anterior crural muscle atrophy or intrinsic muscle wasting can lead to foot deformities such as foot drop, equinus, and hammertoes. In people with diabetes, 22.8% have foot problems such as amputations and numbness, compared with 10% of nondiabetics. Over the age of 40 years old, 30% of people with diabetes have loss of sensation in their feet.

Recognizing important risk factors and making a logical, treatment-oriented assessment of the diabetic foot requires a consistent and thorough diagnostic approach using a common language. Without such a method, the practitioner is more likely to overlook vital information and to pay inordinate attention to less critical points in the evaluation. A useful examination will involve identification of key risk factors and assignment into appropriate risk category. Only then can an effective treatment plan be designed and implemented. (ACFAS Guidelines; American Diabetes Association Standards of Medical Care in Diabetes - 2020)