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:
General Changes
- 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.
Quality Changes
- The specified reporting methods are now topped out for following measures. This means the reporting method is capped at a maximum of 7 points.
- 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 Code New Code Description 3044F M1371 Most recent glycemic status assessment (HbA1c or GMI) level < 7.0% 3051F M1372 Most recent glycemic status assessment (HbA1c or GMI) level ≥ 7.0% and < 8.0% 3052F M1373 Most recent glycemic status assessment (HbA1c or GMI) level ≥ 8.0% and ≤ 9.0% - 019. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care has been revised so that the communication with the physician who manages the patient's diabetic care may occur "soon after" the patient's visit. Previously, the communication had to occur during the visit.
- 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.
Promoting Interoperability Changes
- If you submit promoting interoperability multiple times, CMS will now use the highest of the scores.
Improvement Activities Changes
- 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.
Cost Changes
- 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.