QID 477 · Multimodal Pain Management

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 undergoing selected surgical procedures that were managed with multimodal pain management.

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: 97.47%. Historical benchmark. TOPPED OUT. Not yet subject to the 7-point cap for 2026.

INSTRUCTIONS

Report each time a patient undergoes a selected surgical procedure during the reporting period.

DENOMINATOR

Patients aged 18 years and older who undergo selected surgical procedures.

DENOMINATOR NOTE: Selected surgical procedures include both elective and urgent open and laparoscopic intra-abdominal, spinal, pelvic, thoracic, breast, joint, head, neck, orthopedic, and fracture repair surgeries.

Denominator Criteria (Eligible Cases): - Patients aged 18 years and older on date of encounter - AND Patient procedure during the reporting period matching the measure's CPT list. This is a much narrower list than the other CMS measures: 98 codes selected for the procedure categories above. The full list appears at the end of this measure.

DENOMINATOR EXCLUSION

- Emergent cases (M1142)

NUMERATOR

Patients for whom multimodal pain management is administered in the perioperative period, from 6 hours prior to anesthesia start time until discharge from the post-anesthesia care unit.

Definition: Multimodal pain management is the use of two or more drugs and/or interventions, NOT including systemic opioids, that act by different mechanisms to provide analgesia. These drugs and interventions can be administered via the same route or by different routes. Opioids may be administered for pain relief when indicated but do not count toward this measure.

NUMERATOR NOTE: Documentation of qualifying medications or interventions provided from six hours prior to anesthesia start time through PACU discharge counts toward the numerator.

Performance Met: G2148 Multimodal pain management was used OR Denominator Exception: G2149 Documentation of medical reason(s) for not using multimodal pain management (for example, allergy to multiple classes of analgesics, intubated patient, hepatic failure, patient reports no pain during PACU stay, other medical reasons) OR Performance Not Met: G2150 Multimodal pain management was not used

RATIONALE

Besides providing anesthesia care in the operating room, anesthesiologists are dedicated to providing the best perioperative pain management in order to improve patients' function and facilitate rehabilitation after surgery. In the past, pain management was limited to opioids. Opioids provide analgesia primarily through a unitary mechanism, and simply adding more opioids does not usually lead to better pain control or improved outcomes. Opioids are responsible for a host of side effects that can be life-threatening, and increasing rates of postoperative complications can be attributed to opioid overuse and abuse.

In 2012 the ASA published guidelines for acute pain management in the perioperative setting, and in 2016 ASA, ASRA, and the American Pain Society collaborated on clinical practice guidelines for the management of postoperative pain. These documents endorse the routine use of multimodal analgesia, employing multiple classes of pain medications or therapies working through different mechanisms of action, rather than relying on opioids alone.

Qualifying classes include, but are not limited to:

• Non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen, diclofenac, ketorolac, celecoxib, nabumetone. NSAIDs act on the prostaglandin system peripherally and decrease inflammation.
• NMDA antagonists: in low dose, ketamine, magnesium, and other NMDA antagonists act on N-methyl-D-aspartate receptors in the central nervous system to decrease acute pain and hyperalgesia.
• Acetaminophen: acts on central prostaglandin synthesis and provides pain relief through multiple mechanisms.
• Gabapentinoids: gabapentin and pregabalin are membrane stabilizers that decrease nerve firing.
• Regional block: ASA and ASRA strongly recommend target-specific local anesthetic application in the form of regional analgesic techniques as part of a multimodal protocol whenever indicated.
• Steroids: dexamethasone during surgery has been shown to decrease pain and opioid requirements.
• Local anesthetics: injection of local anesthetic in or around the surgical site by the surgeon. Systemic lidocaine administered intravenously is an alternative to regional analgesic techniques.

RELEVANT FIELDS (Graphium capture)

- Date of procedure, date of birth - ASA CPT code and surgical CPT code - Emergency status - All analgesic medications administered from 6 hours pre-anesthesia through PACU discharge, with drug class - Regional blocks performed - Local anesthetic infiltration - Documented medical reason for not using multimodal management

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.

98 anesthesia CPT codes:

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