2026 MIPS Measure #335: Maternity Care: Elective Delivery (Without Medical Indication) at < 39 Weeks (Overuse)

Percentage of patients, regardless of age, who gave birth during a 12-month period, delivered a live singleton at < 39 weeks of gestation, and had elective deliveries (without medical indication) by cesarean birth or induction of labor.

This measure is to be submitted each time a procedure is performed for patients undergoing delivery by cesarean birth or induction of labor at less than 39 weeks of gestation 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.

All patients, regardless of age, who gave birth during a 12-month period delivering a live singleton at < 39 weeks of gestation

All patients, regardless of age

AND

Single live birth during the performance period (ICD-10-CM): Z37.0

AND

Patient procedure during performance period (CPT): 59400, 59409, 59410, 59510, 59514, 59515, 59610, 59612, 59614, 59618, 59620, 59622

WITHOUT

Telehealth Modifier (including but not limited to): GQ, GT, POS 02, POS 10

AND

Delivery at < 39 weeks of gestation: M1444

Patients who had elective deliveries (without medical indication) by cesarean birth or induction of labor

Numerator Instructions:
INVERSE MEASURE – A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care.

Performance Met: Elective delivery (without medical indication) by cesarean birth or induction of labor performed (< 39 weeks of gestation) (G9356)

OR

Denominator Exception: Medical indication for delivery by cesarean birth or induction of labor (< 39 weeks of gestation) [Documentation of reason(s) for elective delivery (e.g., hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes (premature or prolonged), maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in clinical trial)] (G9361)

OR

Performance Not Met: Elective delivery (without medical indication) by cesarean birth or induction of labor not performed (< 39 weeks of gestation) (G9355)

Elective delivery or early induction often leads to prematurity, increased costs, and an increased incidence of cesarean birth. Studies have determined that elective delivery prior to the gestational age of 39 weeks may result in significant short-term neonatal morbidity (neonatal intensive care unit admission rates of 13%–21%). Recent research shows that infants born prior to 39 weeks face a higher risk of breathing disorders and other problems than those who remain in the uterus longer [1].

Substantial disparities exist in the prevalence of preterm birth, fetal demise, maternal mortality, neonatal mortality, and obstetric care utilization [2]. As noted by Kozhimannil et al., “differences in cesarean use or labor induction, including differences not driven my medical need, may contribute to racial disparities in neonatal and maternal outcomes” [3]. A retrospective study of vital statistics found that disorders related to short gestation and low birth weight were the secondleading cause of fetal demise and that Black, American Indian, and Puerto Rican women experience the highest risk of unfavorable birth outcomes [4]. Black-White differences in early elective delivery have been recognized, with Black women having 30 percent higher odds of early elective cesarean compared to non-Hispanic White women [3]. At least one study found that policy change effectively eliminating early delivery eliminated Black-White differences in early elective cesarean [3], suggesting that successful implementation of this measure’s intent may have positive downstream impacts on disparities in maternal and fetal outcomes overall.

References

1. Clark, S. L., Miller, D. D., Belfort, M. A., Dildy, G. A., Frye, D. K., & Meyers, J. A. (2009). Neonatal and maternal outcomes associated with elective term delivery. American Journal of Obstetrics and Gynecology, 200(2), 156.e1– 156.e1564. https://doi.org/10.1016/j.ajog.2008.08.068

2. Bryant, A.S., Worjoloh, A., Caughey, A.B., Washington, E. (2010). Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. American Journal of Obstetrics and Gynecology, 202(4), 335-343. https://doi.org/10.1016/j.ajog.2009.10.864

3. Kozhimannil, K.B., Muoto, I., Darney, B.G., Caughey, A.B., Snowden, J.M. (2018). Early elective delivery disparities between non-hispanic black and white women after statewide policy implementation. Women's Health Issues, 28(3), 224–231. https://doi.org/10.1016/j.whi.2017.11.008

4. MacDorman, M.F. (2011). Race and ethnic disparities in fetal mortality, preterm birth, and infant mortality in the United States: an overview, Seminars in Perinatology, 35(4), 200-208. https://doi.org/10.1053/j.semperi.2011.02.017