001. Diabetes: Glycemic Status Assessment > 9%
Percentage of patients 18–75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period. This is an outcome measure.
This measure is to be reported a minimum of once per performance period for patients with diabetes seen during the performance period. The most recent quality-data code submitted will be used for performance calculation. This measure may be reported by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
Ranges and thresholds do not meet criteria for this indicator. A distinct numeric result is required for numerator compliance. Do not include HbA1c or GMI levels reported by the patient.
This is an 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. Reporting that numerator option will produce a performance rate that trends closer to 0%, as quality increases.
Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.

Document the diabetic patient’s A1c levels:
- Open the Ocular Exam.
- Select a diabetes Diagnosis.
- Select a counseling Plan.
- Select the appropriate condition from the Quality 1 drop-down.
Alternatively, code quality with a special plan:
- Open the Ocular Exam.
- Select a Diagnosis and Plan.
- Tap Special Plans and select MIPS.
- From Popular Plans, select MIPS Quality.
- Tap the Diabetes tab.
- Select the appropriate condition from the Quality 1 drop-down.
- Tap Done.

- Claims
- Registry

This topic describes how points are calculated for this measure. To learn more about scoring, go to Scoring.
Benchmarks are displayed here as both a chart and a table. The chart gives you a visual representation and helps you quickly compare benchmarks across different reporting methods. The table lists the specific benchmark criteria for each available reporting method.
This is an 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. Reporting that numerator option will produce a performance rate that trends closer to 0%, as quality increases.
Submission Method | 3rd Decile | 4th Decile | 5th Decile | 6th Decile | 7th Decile | 8th Decile | 9th Decile | 10th Decile |
---|---|---|---|---|---|---|---|---|
Claims | 80.00– 70.01 | 70.00– 60.01 | 60.00– 50.01 | 50.00– 40.01 | 40.00– 30.01 | 30.00– 20.01 | 20.00– 10.01 | ≤ 10.00 |
Registry | 80.00– 70.01 | 70.00– 60.01 | 60.00– 50.01 | 50.00– 40.01 | 40.00– 30.01 | 30.00– 20.01 | 20.00– 10.01 | ≤ 10.00 |

Patients aged 18 to 75 years on the date of the encounter;
AND who had a diagnosis of diabetes:
E10.A2, 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, E10.36, E10.37X1, E10.37X2, E10.37X3, E10.37X9, 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, E11.00, E11.01, 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, E11.36, E11.37X1, E11.37X2, E11.37X3, E11.37X9, 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, E13.339, 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, E13.36, E13.37X1, E13.37X2, E13.37X3, E13.37X9, 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, O24.011, O24.012, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112, O24.113, O24.119, O24.12, O24.13, O24.311, O24.312, O24.313, O24.319, O24.32, O24.33, O24.811, O24.812, O24.813, O24.819, O24.82, O24.83
AND who had a visit during the measurement period:
97802, 97803, 97804, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, G0270, G0271, G0402, G0438, G0439
92000 series codes are not included in this measure.
Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, or POS 02 modifiers) are allowable; however, specific denominator codes within the encounter may not be telehealth eligible.
CPT codes listed with an asterisk (*) are noncovered services under the Physician Fee Schedule and will not be counted toward the denominator in claims-based reporting.
Denominator Exclusions
Hospice services given to patient any time during the measurement period:
G9687
Palliative care services provided to patient any time during the measurement period:
G9988
Patients age 66 and older in Institutional Special Needs Plans (SNP) or residing in long-term care with a POS code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period:
G2081
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND a dispensed medication for dementia during the measurement period or the year prior to the measurement period :
G2090
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND an advanced illness diagnosis during the measurement period or the year prior to the measurement period:
G2091

Patients who are included in the denominator
AND whose most recent glycemic status assessment (HbA1c or GMI) ( (performed during the measurement period) is > 9.0% or is missing, or was not performed during the measurement period
Performance Met
Most recent glycemic status assessment (HbA1c or GMI) level greater than 9.0%:
M1211
OR glycemic status assessment (HbA1c or GMI) level is missing, or was not performed during the measurement period:
M1212
Performance Not Met
Most recent glycemic status assessment (HbA1c or GMI) level less than 7.0%:
M1371
OR most recent glycemic status assessment (HbA1c or GMI) level ≥ 7.0% and < 8.0%:
M1372
OR most recent glycemic status assessment (HbA1c or GMI) level ≥ 8.0% and ≤ 9.0%:
M1373