QID 430 · Prevention of Post-Operative Nausea and Vomiting (PONV), Combination Therapy

Steward: CMS | Collection Type: MIPS CQM 2026 Status: Active. Included in the CMS-recommended Anesthesiology Measure Set. Available in the Anesthesia MVP.

MEASURE DESCRIPTION

Percentage of patients aged 18 years and older who undergo a procedure under an inhalational general anesthetic AND who have three or more risk factors for post-operative nausea and vomiting, who receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively.

MEASURE TYPE: Process HIGH PRIORITY STATUS: Yes INVERSE MEASURE: No | RISK ADJUSTED: No NUMBER OF PERFORMANCE RATES: 1 REPORTING OPTIONS: MVP and Traditional MIPS

2026 BENCHMARK

National average performance rate: 99.34%. Historical benchmark. TOPPED OUT. Not yet subject to the 7-point cap for 2026.

Reading this benchmark: the national average is 99.34%, which sits in Decile 9. Practically everyone performs at or near ceiling. Full 10 points requires a literal 100%. Plan for the 7-point cap to arrive in a future performance year and make sure your six-measure strategy does not depend on this measure carrying full weight indefinitely. ASA formally opposed CMS's removal of topped-out anesthesia measures in its CY 2026 comments, but the direction of travel is clear.

INSTRUCTIONS

Submit each time any surgical, therapeutic, or diagnostic procedure under an inhalational general anesthetic is performed during the performance period. There is no diagnosis associated with this measure.

DENOMINATOR

All patients aged 18 years and older who undergo any procedure including surgical, therapeutic, or diagnostic under an inhalational general anesthetic, AND who have three or more risk factors for PONV.

Definition, PONV Risk Factors: - Female gender - History of PONV - History of motion sickness - Non-smoker - Intended administration of opioids for post-operative analgesia. This includes opioids given intraoperatively whose effects extend into the PACU or postoperative period, opioids given in the PACU, or opioids given after PACU discharge.

Denominator Criteria (Eligible Cases): - Patients aged 18 years or older on date of service - AND Patient procedure during the performance period matching the measure's CPT list (255 codes; the full list appears at the end of this measure) - AND Patient received inhalational anesthetic agent (4554F) - AND Patient exhibits 3 or more risk factors for post-operative nausea and vomiting (4556F)

NUMERATOR

Patients who receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively.

Definition, Anti-emetic Therapy: The recommended first- and second-line classes of pharmacologic anti-emetics for PONV prophylaxis in patients at moderate to severe risk include, but are not limited to: - NK-1 receptor antagonists - 5-hydroxytryptamine (5-HT3) receptor antagonists - Glucocorticoids - Phenothiazines - Phenylethylamines - Butyrophenones - Antihistamines - Anticholinergics

NOTE: This list is based on clinical guidelines and evidence, and may not be current. Refer to the FDA's Drug Safety Communications page for up-to-date recall and alert information when prescribing.

Performance Met: G9775 Patient received at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively OR Denominator Exception: G9776 Documentation of medical reason for not receiving at least 2 prophylactic pharmacologic anti-emetic agents of different classes (for example, intolerance or other medical reason) OR Performance Not Met: G9777 Patient did not receive at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively

RATIONALE

Postoperative nausea and vomiting is an important patient-centered outcome of anesthesia care. PONV is highly dissatisfying to patients, though rarely life-threatening. A large body of scientific literature has defined risk factors for PONV, demonstrated effective prophylactic regimens based on those risk factors, and demonstrated high variability in this outcome across individual centers and providers. Several papers have shown that performance can be assessed at the level of individual providers, since the outcome is common enough that sufficient power exists to assess variability and improvement at that level.

RELEVANT FIELDS (Graphium capture)

- Date of procedure, date of birth - ASA CPT code - Received inhalational agent - Each of the five PONV risk factors, individually - Count of PONV risk factors (3 or more) - Anti-emetic agents administered, with drug class - Documented medical reason for not administering

REPORTING CODES

DENOMINATOR CPT CODES

A case must carry one of the codes below to enter this measure's denominator. The other denominator criteria above still apply - a matching code makes a case eligible for consideration, not automatically countable.

255 anesthesia CPT codes:

Source: CMS 2026 MIPS measure specification. CPT copyright American Medical Association.