QID 463 · Prevention of Post-Operative Vomiting (POV), Combination Therapy (Pediatrics)

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 3 through 17 years who undergo a procedure under general anesthesia in which an inhalational anesthetic is used for maintenance AND who have two or more risk factors for post-operative 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: 98.99%. Historical benchmark. TOPPED OUT. Not yet subject to the 7-point cap for 2026.

Reading this benchmark: identical decile structure to QID 430, and the same caution applies. This measure is also only usable by groups with pediatric volume, and a group with a small pediatric denominator can see wild swings in its rate from a handful of cases.

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 3 through 17 years who undergo a procedure under general anesthesia in which an inhalational anesthetic is used for maintenance AND who have two or more risk factors for POV.

Definition, POV Risk Factors: - Surgery 30 minutes or longer - Age 3 years or older - Strabismus surgery - History of POV, or PONV/motion sickness, in the patient - Family history of POV/PONV - Post-pubertal female - Adenotonsillectomy - Otoplasty - Anticholinesterases - Long-acting opioids

Denominator Criteria (Eligible Cases): - Patients aged 3 through 17 years on date of service - AND Patient procedure during the performance period matching the measure's CPT list (265 codes; the full list appears at the end of this measure) - AND Patient received inhalational anesthetic agent (4554F) - AND Patient exhibits 2 or more risk factors for post-operative vomiting (G9954)

DENOMINATOR EXCLUSION

- Cases in which an inhalational anesthetic is used only for induction (G9955)

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 pharmacologic anti-emetics for POV prophylaxis in pediatric patients at risk include, but may not be limited to: - 5-hydroxytryptamine (5-HT3) receptor antagonists (recommended as first choice for POV prophylaxis in children) - Propofol for induction and maintenance of anesthesia - Dexamethasone - Antihistamines - Butyrophenones

NOTE: This list is based on clinical guidelines and evidence, and may not be current. Refer to the FDA's Drug Safety Communications page.

Numerator Instructions: Denominator exceptions should be determined or confirmed at the date of the denominator-eligible procedure.

Performance Met: G9956 Patient received combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively OR Denominator Exception: G9957 Documentation of medical reason for not receiving combination therapy (for example, intolerance or other medical reason) OR Performance Not Met: G9958 Patient did not receive combination therapy consisting of at least two 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. 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 across centers and providers.

Between 62% and 73% of children experience POV when prophylactic anti-emetics are not administered. Beyond the discomfort of the condition, POV is a comorbidity that can cause significant postoperative complications including dehydration and postoperative bleeding. In several studies, the incidence of POV decreased significantly in children receiving combination therapy compared to control groups. A separate measure is needed for pediatric patients because the risk factors and recommended prophylaxis differ from adults.

RELEVANT FIELDS (Graphium capture)

- Date of procedure, date of birth - ASA CPT code - Received maintenance inhalational agent (not induction only) - Each of the ten POV risk factors, individually - Count of POV risk factors (2 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.

265 anesthesia CPT codes:

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