What's New in 2025

This page summarizes substantive changes to the traditional MIPS program as they apply to optometry and ophthalmology. The information presented here is not intended to be comprehensive. Refer to the individual measure topics for specifics. Here's what's new this performance year:

  • Eyecare professionals are now eligible for, but not required to participate in, MVPs. MVP stands for MIPS Value Pathways (that's right, an acronym within an acronym!). Eyefinity is readying its certified EHR solutions to support MVP starting with the 2026 performance year. To support eyecare professionals, CMS introduced the Complete Ophthalmologic MVP, which is applicable to optometry and ophthalmology:
    • Assess meaningful outcomes in cataract, glaucoma, retinal detachment, and ocular care.
    • Includes 18 MIPS quality measures.
    • Includes 14 improvement activities.
    • Includes one cost measure.

      Learn more about Complete Ophthalmic Care (MVP ID: M1420) on the QPP website.

  • The specified reporting methods are now topped out for following measures. This means the reporting method is capped at a maximum of 7 points.
    MeasureReporting Method
    141. Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 20% or Documentation of a Plan of Care

    Claims

    226. Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

    Claims

    Registry

  • Modifier 95 was removed from all measure specifications that allowed telehealth encounters.
  • 001. Diabetes: Glycemic Status Assessment > 9% has been renamed. Formerly, it was called "Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)." This measure was also updated to specify that the test used to determine the numerator compliance must be part of the patient's medical record. Previously, this guidance simply stated that the test had to be a lab test and could not be patient-reported. The following "performance not met codes" have been replaced:
    Old CodeNew CodeDescription
    3044FM1371Most recent glycemic status assessment (HbA1c or GMI) level < 7.0%
    3051FM1372Most recent glycemic status assessment (HbA1c or GMI) level ≥ 7.0% and < 8.0%
    3052FM1373Most recent glycemic status assessment (HbA1c or GMI) level ≥ 8.0% and ≤ 9.0%
  • Measure 19, "Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care," has been retired from the MIPS CPM collection type and is therefore, no longer available in Encompass.
  • 117. Diabetes: Eye Exam was updated to remove specific encounter requirements from the frailty and advanced illness exclusion.
  • 374. Closing the Referral Loop: Receipt of Specialist Report has been updated to allow you to document the patient did not attend the follow-up. This enables you to close the referral loop regardless of whether the patient showed up for the follow-up appointment or not.
  • If you submit promoting interoperability multiple times, CMS will now use the highest of the scores.
  • CMS streamlined how improvement activities are measured for small and large practices. Rather than requiring you to cobble together a combination of medium- and high-weighted measures, small and rural practices are required to report one activity, and large practices are required to report two activities.
  • The "COVID-19 Vaccine Achievement for Practice Staff" (IA_ERP_6) activity has been removed and replaced with the "Vaccine Achievement for Practice Staff: COVID-19, Influenza, and Hepatitis B" (IA_PM_26) activity.
  • CMS added five new Cost measures, but none apply to eyecare.
  • CMS made substantive changes to the Cataract Removal with Intraocular Lens (IOL) measure.
  • CMS made changes to the scoring methodology for the cost category retroactive to data submitted for 2024. The new scoring scheme is based on median, standard deviation, and an achievement point value based on the performance threshold. The median is based on a point value of 7.5 rather than 5 points, and each benchmark is calculated based on standard deviations.