• IRIS26: Avoidance of routine antibiotic use in patients before or after intravitreal injections

    Updated December 2021. This measure is not approved for 2022. Changes for 2021 are indicated in red.

    Care Setting: Ambulatory Care: Clinician Office/Clinic

    Reporting Options: 

    • IRIS Registry QCDR for EHR: groups and individuals
    • IRIS Registry QCDR manual data entry: groups and individuals

    Measure Type: Resource Use

    NQS Domain: Efficiency and Cost Reduction

    Meaningful Measure Area: Appropriate Use of Healthcare

    Description:  The percentage of patients, aged 18 years and older, who received topical or systemic antibiotics before or after intravitreal injections, except for endophthalmitis.

    Risk Adjusted: No 
    Performance Rate: 1
    High Priority Measure: Yes 
    Inverse Measure: Yes
    Proportional Measure

    To Which Patients Does the Measure Apply?

    Denominator: Patients aged 18 years or older who received topical or systemic antibiotics before or after intravitreal injections except for endophthalmitis.

    There are two criteria for inclusion of a patient into the denominator.

    1. Patient characteristics: Description located in “Denominator” (see above)
    2. Procedure codes (CPT): Codes located in “CPT Codes” 

    CPT Codes

    Treatment with Anti-VEGF Agents OR Intravitreal Steroids OR Laser Photocoagulation


    • Bevacizumab (Avastin®) injections (CPT: 67028 & HCPCS: J9035; CPT: 67028 & HCPCS: J3490; CPT: 67028 & HCPCS: J3590; CPT: 67028 & HCPCS: C9257; CPT: 67028 & HCPCS: J7999; CPT: 67028 & HCPCS: Q5107; CPT: 67028 & HCPCS: Q9977)
    • Ranibizumab (Lucentis®) injections (CPT: 67028 & HCPCS: J2778)
    • Aflibercept (EYLEA®) injections (CPT: 67028 & HCPCS: J0178)


    • Fluocinolone acetonide (Iluvien) injections (CPT: 67028 & HCPCS: J7311)
    • Dexamethasone (Ozurdex) injections (CPT: 67028 & HCPCS: J7312)
    • Triamcinalone (Kenalog) injections (CPT: 67028 & HCPCS: J3301)
    • Triamcinolone acetonide  (Triesence) injections (CPT: 67028 & HCPCS: J3300)

    How to Report the Measure

    Numerator: Patients who received antibiotics before or after intravitreal injections (same day). 

    How CMS Scores Your Performance

    No scoring benchmark currently exists for this measure.

    • If you successfully report a measure for less than 70% of your patients, you will earn points based on your practice size:
      • Small practices (≤ 15 clinicians) will receive 3 points,
      • Larger practices (> 15 clinicians) will receive 0 points.
    • If you successfully report a measure for at least 70% of your patients, but do not report at least 20 cases, you will receive 3 points.

    If at least 20 physicians report the measure on at least 70% of qualifying patients and at least 20 patients, CMS will develop a scoring benchmark using data collected during the 2020 reporting year.


    See the QPP resource library for benchmarks.


    This measure has been developed by the H. Dunbar Hoskins Jr. MD Center for Quality Eye Care of the American Academy of Ophthalmology. The measure is not a clinical guideline and does not establish a medical standard. It has not been tested in all possible applications.

    The measure, while copyrighted, can be reproduced and distributed with appropriate credit, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. The American Academy of Ophthalmology encourages use of the measure by other health care professionals, where applicable.

    Commercial use is defined as the sale, license or distribution of the measures for commercial gain, or incorporation of some or all of a measure into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the measures require a license agreement between the user and the American Academy of Ophthalmology. Neither the Academy nor its members shall be responsible for any use of the measures. 


    © 2017-2022 American Academy of Ophthalmology. All rights reserved. Limited proprietary coding from Current Procedural Terminology (CPT®) is contained in the measure specifications. Users of this code set should obtain all necessary licenses. The Academy disclaims all liability for use or accuracy of the coding contained in these measure specifications. CPT® contained in the measures specifications is copyright 2022 American Medical Association.