Quality ID #116 (NQF 0058): Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis

—National Quality Strategy Domain: Efficiency and Cost Reduction

—Meaningful Measure Area: Appropriate Use of Healthcare




Process – High Priority


The percentage of episodes for patients ages 3 months and older with a diagnosis of acute bronchitis/bronchiolitis that did not result in an antibiotic dispensing event


This measure is to be submitted at each occurrence of acute bronchitis/bronchiolitis during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

NOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.

Measure Submission Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.


All patients aged 3 months or older with an outpatient visit, telephone visit, e-visit or virtual check-in, observation visit or emergency department (ED) visit with a diagnosis of acute bronchitis/bronchiolitis during the measurement period

DENOMINATOR NOTE: Do not include visits that result in an inpatient admission. When a visit and an inpatient stay are billed on separate claims, the visit results in an inpatient stay when the visit date of service occurs on the day prior to the admission date or any time during the admission (admission date through discharge date). A visit billed on the same claim as an inpatient stay is considered a visit that resulted in an inpatient stay.

*Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.

Denominator Criteria (Eligible Cases):

Patients 3 months of age and older on date of encounter


Diagnosis for acute bronchitis/bronchiolitis (ICD-10-CM): J20.3, J20.4, J20.5, J20.6, J20.7, J20.8, J20.9, J21.0, J21.1, J21.8, J21.9


Patient encounter during the performance period (CPT or HCPCS): 98966, 98967, 98968, 98969, 98970, 98971, 98972, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99241*, 99242*, 99243*, 99244*, 99245*, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99381*, 99382*, 99383*, 99384*, 99385*, 99386*, 99387*, 99391*, 99392*, 99393*, 99394*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99421, 99422, 99429*, 99441, 99442, 99443, 99444, 99455, 99456, 99483, G0402, G0438, G0439, G0463*, T1015*



Outpatient, ED or Observation visits that result in an inpatient admission: G2176


Acute bronchitis/bronchiolitis episodes when the patient had a new or refill prescription of antibiotics (Table 1) in the 30 days prior to the episode date: G2177


Documentation of medical reason(s) for prescribing or dispensing antibiotic (e.g., intestinal infection, pertussis, bacterial infection, Lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis/ mastoiditis/bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia, gonococcal infections/venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis/UTI, acne, HIV disease/asymptomatic HIV, cystic fibrosis, disorders of the immune system, malignancy neoplasms, chronic bronchitis, emphysema, bronchiectasis, extrinsic allergic alveolitis, chronic airway obstruction, chronic obstructive asthma, pneumoconiosis and other lung disease due to external agents, other diseases of the respiratory system, and tuberculosis): G9712


Patients who use hospice services any time during the measurement period: G9713


Patients who were not prescribed or dispensed antibiotics (Table 1) on or within 3 days of the initial date of service

Numerator Instructions:

For performance, the measure will be calculated as the number of patient encounters where antibiotics were neither prescribed nor dispensed on or within 3 days of the episode for acute bronchitis/bronchiolitis over the total number of encounters in the denominator (patients aged 3 months and older with an outpatient, telephone, e-visit or virtual check-in, observation or ED visit for acute bronchitis/bronchiolitis). A higher score indicates appropriate treatment of patients with acute bronchitis/bronchiolitis (e.g., the proportion for whom antibiotics were not prescribed or dispensed on or three days after the encounter). Delayed prescriptions (where an antibiotic was prescribed and patient was instructed to delay taking the antibiotic) are considered “Performance Not Met”.

Table 1 – Antibiotic Medications

Note: This list should be used when assessing antibiotic prescriptions for the denominator exclusion and numerator components.

 Description Prescription
Aminoglycosides Amikacin Tobramycin Gentamicin Streptomycin
Aminopenicillins Amoxicillin Ampicillin
Beta-lactamase inhibitors Amoxicillin-clavulanate Ampicillin- sulbactam Piperacillin-tazobactam
 First-generation cephalosporins Cefadroxil Cephalexin Cefazolin
Fourth-generation cephalosporins Cefepime
Ketolides Telithromycin
Lincomycin derivatives Clindamycin Lincomycin
Macrolides Azithromycin Clarithromycin Erythromycin stearate Erythromycin

Erythromycin ethylsuccinate Erythromycin lactobionate

Miscellaneous antibiotics Aztreonam Chloramphenicol Vancomycin Dalfopristin-quinupristin Linezolid Daptomycin Metronidazole
Natural penicillins Penicillin G benzathine- procaine

Penicillin G potassium Penicillin G procaine

Penicillin G sodium Penicillin V potassium Penicillin G benzathine
Penicillinase resistant penicillins Dicloxacillin Oxacillin Nafcillin
Quinolones Ciprofloxacin Gemifloxacin Ofloxacin Levofloxacin Moxifloxacin
Rifamycin derivatives Rifampin
Second generation cephalosporin Cefaclor Cefotetan Cefprozil Cefoxitin


Sulfonamides Sulfadiazine Sulfamethoxazole-trimethoprim
Tetracyclines Doxycycline Tetracycline Minocycline
Third generation cephalosporins Cefdinir




Cefotaxime Ceftibuten Ceftriaxone


Numerator Options:

Performance Met: Antibiotic neither prescribed nor dispensed (4124F)


Performance Not Met: Antibiotic prescribed or dispensed (4120F)