Pathology Quality Measures


Through the development of quality measures by the CAP, pathologists avoid Medicare payment penalties and earn bonuses when reported correctly. In 2016, for example, pathologists faced a combined $30.9 million in penalties from Medicare’s quality programs if measures were not successfully reported. Previously, pathologists also earned $25 million in Medicare bonuses after reporting quality measures developed by the CAP and its Council on Government and Professional Affairs.


CAP Advocacy

The CAP advocates on behalf of pathologists regarding their options for quality reporting. While the CAP has created eight quality measures included in the current CMS quality program for pathologists, other measures in the current MIPS program may apply. In 2017, most specialties must report on a minimum of six measures (or all that apply).

The CMS has assured the CAP—in writing—that pathologists who have fewer than nine measures will only need to report on applicable measures, and pathologists with no applicable measures will not face PQRS penalties. CMS has said it will continue this policy through 2017, but has not provided that in writing. The CMS recommends that eligible professionals check with the QualityNet HelpDesk to make sure that no measures apply.

Professionals may Contact the Qualitynet Help Desk.
7:00 AM–7:00 PM CT Monday - Friday
Phone: 866-288-8912

Letter To CMS Acting Administrator Andy Slavitt On Physician Quality Reporting System (PQRS) And Value-based Modifier (VBM) Provisions Of Proposed Rule (CMS-1600-P)

Claims-Based Instruction Sheet

The CAP developed a Claims-Based Instruction Sheet to help you submit data for on a quality measures data via claims for MIPS under the Quality Payment Program. The corresponding 2017 QPP Reporting Codes can help on which codes to report.


A number of resources exist to help pathologists navigate the rules for PQRS, understand their options for reporting, and successfully report measures.


The 2016 Medicare Physician Fee Schedule’s Impact on Pathology Services