2026 MIPS Measure #451: RAS (KRAS and NRAS) Gene Mutation Testing Performed for Patients with Metastatic Colorectal Cancer who Receive Anti-epidermal Growth Factor Receptor (EGFR) Monoclonal Antibody Therapy

Percentage of adult patients (aged 18 or over) with metastatic colorectal cancer who receive anti-epidermal growth factor receptor (EGFR) monoclonal antibody (MoAb) therapy for whom RAS (KRAS and NRAS) gene mutation testing was performed before initiation of anti-EGFR MoAb.

This measure is to be submitted once per performance period for patients with colorectal cancer seen 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.

Adult patients with metastatic colorectal cancer who receive anti-EGFR monoclonal antibody therapy

Denominator Instructions:
The denominator of this measure is intended to capture newly-diagnosed stage IV patients or patients who have distant metastases at the time of colon cancer diagnosis. For the purposes of this measure, the patient’s initial diagnosis may occur between December 1 of the prior year through November 30 of the performance period, and anti-EGFR monoclonal antibody therapy may occur between December 1 of the prior year through December 31 of the performance period.

DENOMINATOR NOTE: The patient must have two encounters during the performance period. This is intended to reflect two separate encounters with the same reporting provider/group during this timeframe. There is no specific timeframe for the requirement for the two encounters that occur during the performance period. For example, two encounters with the same provider/group could occur in the same week. However, two encounters should not be counted if they occur on the same day. For example, the patient has two encounters and one is with a different provider on the same day.

Adult patients (aged 18 or over) with metastatic colorectal cancer who receive anti-EGFR monoclonal antibody therapy.

AND

Diagnosis of initial colon or rectal cancer on date of encounter (ICD-10 CM): C18.0, C18.2, C18.3, C18.4, C18.5, C18.6, C18.7, C18.8, C18.9, C19, C20

AND

At least two patient encounters during the performance period (CPT): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215

WITHOUT

Encounters conducted via telehealth: M1426

AND

Patient has metastatic disease at diagnosis: G9838

AND

Anti-EGFR monoclonal antibody therapy: G9839

RAS (KRAS and NRAS) gene mutation testing performed before initiation of anti-EGFR MoAb

RAS mutation testing - RAS testing for this measure refers to assays that detect mutations in codons 12 and 13 of exon 2, codons 59 and 61 of exon 3 and codons 117 and 146 in exon 4 in KRAS or NRAS. Do not include results from mutations at other codons or assays for other alterations (e.g., BRAF, PI3K, PTEN genes). The College of American Pathologists (CAP) Perspectives on Emerging Technology (POET) Report on RAS mutation testing provides additional guidance on testing.

If multiple RAS mutation tests have been performed, refer to the most recent test results.

Anti-EGFR monoclonal antibody includes cetuximab or panitumumab.

Numerator Instructions:
In the absence of any documentation regarding testing for the RAS (KRAS and NRAS) gene mutation, submit G9841: RAS (KRAS and NRAS) gene mutation testing not performed before initiation of anti-EGFR MoAb. Report G9840: RAS (KRAS and NRAS) gene mutation testing performed before initiation of antiEGFR MoAb, if the report indicates a mutation within codons 12 and 13 of exon 2, codons 59 and 61 of exon 3 and codons 117 and 146 in exon 4 in KRAS or NRAS, where KRAS or NRAS gene was detected in the DNA extracted from the colon tumor specimen.

Performance Met: RAS (KRAS and NRAS) gene mutation testing performed before initiation of anti-EGFR MoAb (G9840)

OR

Performance Not Met: RAS (KRAS and NRAS) gene mutation testing not performed before initiation of anti-EGFR MoAb (G9841)

The American Society of Clinical Oncology (ASCO) envisions that use of this measure will improve concordance with recommendations for RAS (KRAS and NRAS) testing for patients with metastatic colorectal cancer. We recognize the importance of ensuring that the appropriate patient population receives guideline concordant treatment as studies demonstrate that the administration of EGFR-targeted therapies, specifically cetuximab or panitumumab, offer no clinical benefit to patients diagnosed with KRAS-mutated or NRAS-mutated tumors. Clinical trial data strongly suggest that patients with RAS mutations are better served with other targeted therapies, especially considering the harms and costs of anti-EGFR treatment. Therefore, the measure focus is on halting use of antiEGFR MoAb therapies in patients who will not derive any benefit.