2026 MIPS Measure #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

Percentage of patient visits for patients aged 18 years and older seen during the measurement period who were screened for high blood pressure AND a recommended follow-up plan is documented, as indicated, if blood pressure is elevated or hypertensive.

This measure is to be submitted at each visit for patients seen during the performance period. Merit-based Incentive Payment System (MIPS) eligible clinicians who submit the measure must perform the blood pressure (BP) screening at each patient visit by a MIPS eligible clinician and may not obtain measurements from external sources.

This measure may be submitted by MIPS eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding. The intent of this measure is to screen patients for high blood pressure and provide recommended follow-up as indicated. Both the systolic and diastolic blood pressure measurements are required for inclusion. If there are multiple blood pressures on the same date of service, use the most recent (last reading documented) as the representative blood pressure. The documented follow-up plan must be related to the current BP reading as indicated, example: “Patient referred to primary care provider for BP management”.

All patient visits for patients aged 18 years and older at the beginning of the performance period

Definition:
Not Eligible for High Blood Pressure Screening (Denominator Exclusion) –

Patient has an active diagnosis of hypertension prior to the current encounter
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.

Patients aged ? 18 years at the beginning of the performance period

AND

Patient encounter during the performance period (CPT or HCPCS): 90791, 90792, 92002, 92004, 92012, 92014, 92532, 92534, 92537, 92538, 92540, 92541, 92542, 92544, 92545, 92546, 92622, 92625, 97802, 97803, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99236, 99242, 99243, 99244, 99245, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99424, 99491, D3921, D7111, D7140, D7210, D7220, D7230, D7240, D7241, D7250, D7251, G0101, G0270, G0402, G0438, G0439

WITHOUT

Encounters conducted via telehealth: M1442

AND NOT

DENOMINATOR EXCLUSION:

Patient not eligible due to active diagnosis of hypertension: G9744

Patient visits where patients were screened for high blood pressure AND have a recommended follow-up plan documented, as indicated, if the blood pressure is elevated or hypertensive

BLOOD PRESSURE (BP) SCREENING & FOLLOW-UP MEASURE – SUMMARY:

BP CLASSIFICATIONS (2017 ACC/AHA Guideline):

Normal BP:
- SBP < 120 mmHg AND DBP < 80 mmHg

Elevated BP:
- SBP 120-129 mmHg AND DBP < 80 mmHg

First Hypertensive Reading:
- SBP ? 130 mmHg OR DBP ? 80 mmHg
- WITHOUT a previous SBP ? 130 OR DBP ? 80 in the 12 months prior to encounter

Second Hypertensive Reading:
- SBP ? 130 mmHg OR DBP ? 80 mmHg during current encounter
- AND most recent BP within last 12 months also SBP ? 130 OR DBP ? 80

RECOMMENDED BP FOLLOW-UP (must include ALL indicated actions):

Normal BP (<120 AND <80):
- No follow-up required

Elevated BP (120-129 AND <80):
- Rescreen BP within 6 months AND recommended nonpharmacologic interventions
- OR Referral to Alternate/Primary Care Provider

First Hypertensive BP (?130 OR ?80):
- Rescreen BP within 4 weeks AND recommended nonpharmacologic interventions
- OR Referral to Alternate/Primary Care Provider

Second Hypertensive BP (130-139 / 80-89 – NOT ?140/90):
- Recommended nonpharmacologic intervention
- AND reassessment within 6 months
- AND order for laboratory test or ECG for hypertension
- OR Referral to Alternate/Primary Care Provider

Second Hypertensive BP (?140 OR ?90):
- Recommended nonpharmacologic intervention
- AND BP-lowering medication
- AND reassessment within 4 weeks
- AND order for laboratory test or ECG for hypertension
- OR Referral to Alternate/Primary Care Provider

NONPHARMACOLOGIC INTERVENTIONS (Lifestyle Modifications) – must include ?1:
- Weight Reduction
- Heart-healthy diet (e.g., DASH Eating Plan)
- Dietary Sodium Restriction
- Increased Physical Activity
- Moderation in alcohol consumption

DENOMINATOR EXCEPTIONS (Documented Reason for Not Screening or No Follow-Up Plan):
1. Medical reason – urgent/emergent situation where delay would jeopardize patient's health status
2. Patient reason – patient refuses screening or follow-up intervention

NUMERATOR REPORTING CODES:
- G8783 – Normal BP reading documented, follow-up not required (Performance Met)
- G8950 – Elevated or Hypertensive BP reading documented AND indicated follow-up is documented (Performance Met)
- G9745 – Documented reason for not screening or recommending follow-up for high BP (Denominator Exception)
- G8785 – BP reading not documented, reason not given (Performance Not Met)
- G8952 – Elevated or Hypertensive BP reading documented, indicated follow-up not documented, reason not given (Performance Not Met)

NUMERATOR NOTE:
- Although recommended screening interval for normal BP is annually, measure intent requires BP screening and follow-up at EVERY patient visit
- Denominator Exception(s) determined on date of denominator eligible encounter

KEY TAKEAWAYS:
1. Screen BP at every patient visit
2. Classify BP using 4 categories: Normal, Elevated, First Hypertensive, Second Hypertensive
3. Follow-up actions vary by classification – see table below
4. Nonpharmacologic interventions = lifestyle modifications (?1 of 5 options)
5. For Second Hypertensive (?140/90): MUST include BP-lowering medication + lab/ECG + reassess within 4 weeks
6. Document exceptions at time of encounter if applicable
7. Use G8783, G8950, G9745, G8785, or G8952 for reporting

Performance Met: Normal blood pressure reading documented, follow-up not required (G8783)

OR

Performance Met: Elevated or Hypertensive blood pressure reading documented, AND the indicated follow-up is documented (G8950)

OR

Denominator Exception: Documented reason for not screening or recommending a follow-up for high blood pressure (G9745)

OR

Performance Not Met: Blood pressure reading not documented, reason not given (G8785)

OR

Performance Not Met: Elevated or Hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given (G8952)

Hypertension is a prevalent condition that affects approximately 66.9 million people in the United States. It is estimated that about 20-40% of the adult population has hypertension; the majority of people over aged 65 have a hypertension diagnosis (1,2). Winter noted that 1 in 3 American adults have hypertension and the lifetime risk of developing hypertension is 90% (3). The African American population or non-Hispanic Blacks, the elderly, diabetics and those with chronic kidney disease are at increased risk of stroke, myocardial infarction and renal disease. Non-Hispanic Blacks have the highest prevalence at 38.6% (3). Hypertension is a major risk factor for ischemic heart disease, left ventricular hypertrophy, renal failure, stroke and dementia (2). Prevention of hypertension and the treatment of established hypertension are complementary approaches to reducing cardiovascular disease risk in the population, but prevention of hypertension provides the optimal means of reducing risk and avoiding harmful consequences. Periodic BP screening can identify individuals who develop elevated BP over time. More frequent BP screening may be particularly important for individuals with elevated atherosclerotic cardiovascular disease (ASCVD) risk (4).

Hypertension is the most common reason for adult office visits other than pregnancy. Garrison stated that in 2007, 42 million ambulatory visits were attributed to hypertension (5). It also has the highest utilization of prescription drugs. Numerous resources and treatment options are available, yet only about 40- 50% of the hypertensive patients have their blood pressure under control (<140/90) (1,2). In addition to medication non-compliance, poor outcomes are also attributed to poor adherence to lifestyle changes such as a low-sodium diet, weight loss, increased exercise and limiting alcohol intake. Many adults find it difficult to continue medications and lifestyle changes when they are asymptomatic. Symptoms of elevated blood pressure usually do not occur until secondary problems arise such as with vascular diseases (myocardial infarction, stroke, heart failure and renal insufficiency) (2).

Appropriate follow-up after blood pressure measurement is a pivotal component in preventing the progression of hypertension and the development of heart disease. Detection of marginally or fully elevated blood pressure by a specialty clinician warrants referral to a provider familiar with the management of hypertension and prehypertension.

The American College of Cardiology/American Heart Association (ACC/AHA) 2017 Guidelines provide updated recommendations for ASCVD risk. For additional information please refer to the 2017 ACC/AHA guidelines: https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/11/09/11/41/2017-guideline-for-high-bloodpressure-in-adults (4).

Lifestyle modifications have demonstrated effectiveness in lowering blood pressure (6). The synergistic effect of several lifestyle modifications results in greater benefits than a single modification alone. Baseline diagnostic/laboratory testing establishes if a co-existing underlying condition is the etiology of hypertension and evaluates if end organ damage from hypertension has already occurred. Landmark trials such as the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) have repeatedly proven the efficacy of pharmacologic therapy to control blood pressure and reduce the complications of hypertension. A review of 35 studies found that the pharmacist-led interventions involved medication counseling and patient education. Twenty-nine of the 35 studies showed statistically significant improvement in BP levels of the intervention groups at follow-up (7). Follow-up intervals based on blood pressure control have been established by the 2017 ACC/AHA guideline and the United States Preventive Services Task Force (USPSTF).

References

Appleton, S. L., Neo, C., Hill, C. L., Douglas, K. A., & Adams, R. J. (2013). Untreated hypertension: prevalence and patient factors and beliefs associated with under-treatment in a population sample. Journal of Human Hypertension, 27, 453-462. doi:10.1038/jhh.2012.62ID
'Luehr, D., Woolley, T., Burke, R., Dohmen, F., Hayes, R., Johnson, M...., Schoenleber, M. (2012). Hypertension diagnosis and treatment; Institute for Clinical Systems Improvement health care guideline. Updated November, 2012
Winter, K. H., Tuttle, L. A. & Viera, A.J. (2013). Hypertension. Primary Care Clinics in Office Practice, 40, 179-194. doi:10.1016/j.pop.2012.11.008
Whelton, P.K., Carey, R.M., Aronow, W.S., Casey, D.E., Collins, K., Dennison Himmelfarb, C., Depalma, S.M., Gidding, S., Jamerson, K.A., Jones, D.W., MacLaughlin, E.J, Muntener, P., Ovbiaggele, B., Smith, S.C., Spencer, C.C., Stafford, R.S., Taler, S.J., Thomas, R.J., Williams, K. A., Williamson, J.D., Wright, J.T., (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 71(6), e13-e115. doi.org/10.1161/HYP.0000000000000065
Garrison, G. M. & Oberhelman, S. (2013). Screening for hypertension annually compared with current practice. Annals of Family Medicine, 11 (2), 116-121. doi:10.1370/afm.1467
U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute & National High Blood Pressure Education Program (2003). The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7). NIH Publication No. 03-5233
Reeves, L., Robinson, K., McClelland, T., Adedoyin, C., Broeseker, A., and Adunlin, G. (2020). “Pharmacist Interventions in the Management of Blood Pressure Control and Adherence to Antihypertensive Medications: A Systematic Review of Randomized Controlled Trials.” Journal of Pharmacy Practice. Available at https://doi.org/10.1177/0897190020903573. Accessed October 5, 2020

The U.S. Preventive Services Task Force (USPSTF) recommends screening for high blood pressure in adults aged 18 years and older. This is a grade A recommendation (1).

References

U.S. Preventive Services Task Force (2021). Screening for hypertension in adults. US Preventive Services Task Force reaffirmation recommendation statement. Journal of the American Medical Association, 325(16): 1650- 1656.