Specifications Manual for Joint Commission National Quality Measures (v2027A)

Posted: 8/7/2026

Release Notes:
Measure Information Form
Version 2027A

Measure Information Form

Measure Set: Total Hip and Total Knee Replacement Outpatient (THKR-OP)

Set Measure ID: THKR-OP-4

Set Measure ID	Performance Measure Name
THKR-OP-4a	Preoperative Functional/Health Status Assessment - Hip and Knee Overall
THKR-OP-4b	Preoperative Functional/Health Status Assessment - Hip
THKR-OP-4c	Preoperative Functional/Health Status Assessment - Knee

Performance Measure Name: Preoperative Functional/Health Status Assessment

Description: Patients who completed the general health and joint specific functional status assessments within 90 days prior to surgery as specified below:

Hips: [VR-12 or PROMIS-Global] AND [HOOS Jr. (6 questions) or HOOS Pain, Function Daily Living Subscales (27 questions)]

Knees: [VR-12 or PROMIS-Global] AND [KOOS Jr. (7 questions) or KOOS Stiffness, Pain, Function Daily Living Subscales (28 questions)]

The assessment tool must reflect the status of the patient’s health condition, health behavior, or experience with health care from the patient’s perspective, without interpretation of the patient’s response by a clinician or anyone else. The assessment can be completed by phone, mail, email, or in-person.

Rationale: Elective total hip and knee replacement procedures seek to relieve pain and improve function, underscoring the importance of evaluating these outcomes pre and post surgery (Ayers, 2017). Patient-reported outcome measures (PROMs) are standardized instruments that capture a patient’s perspective on their health status including symptoms, physical function, and quality of life.

The Centers for Medicare & Medicaid Services (CMS) has finalized policies to expand the collection and reporting of patient-reported outcomes (PROs) for total hip and total knee arthroplasty across multiple programs (CMS, 2025a, 2026a, 2026b, 2026c). This expansion reflects a national strategy to capture meaningful pre and postoperative PROMs to support clinical care, shared decision-making, and hospital-level quality assessment for elective total hip and knee replacement procedures (Ayers, 2017; CMS, 2025b; Pasqualini et al., 2026).

Informed by the recommendations of the 2015 Patient Reported Outcomes Summit for Total Joint Arthroplasty (American Association of Hip and Knee Surgeons, 2015), this measure aims to advance preoperative PROM collection for total hip and knee arthroplasty procedures while accounting for the administrative burden associated with PRO data capture.

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Patients who completed the general health (VR-12 or PROMIS-Global) AND joint specific functional status assessments (HOOS Jr./subscales or KOOS Jr./subscales) within 90 days prior to surgery.

Included Populations: As above
Excluded Populations:
Data Elements:

CPT® Code Procedure Date

Preoperative Assessments Completed

Preoperative Assessments Completion Date

Denominator Statement: Patients undergoing elective total hip or total knee replacement.

Included Populations:

Patients with a CPT® Code with Modifier as defined in Appendix A: Table 14.01b (Total Hip Replacements-OP), or Table 14.02b (Total Knee Replacements-OP), or Table 14.03b (Bilateral Hip Replacements-OP), or Table 14.04b (Bilateral Knee Replacements-OP)

Excluded Populations:

Patients less than 18 years of age

Patients a CPT® Code with Modifier as defined in Appendix A: Table 14.05b (Partial hip and partial knee replacements-OP), or Table 14.06b (Revision and resurfacing procedures-OP), or Table 14.07b (Removal of implanted devices/prostheses-OP)

Patients with an ICD-10-CM Principal Diagnosis Code or ICD-10-CM Other Diagnosis Code as defined in Appendix A: Table 14.08 (Complication of Internal Fixation Device/Prosthesis), or Table 14.09 (Malignant neoplasm of the pelvis, sacrum, coccyx, lower limbs, or bone/bone marrow or a disseminated malignant neoplasm) or Table 14.10 (Fractures)

Data Elements:

Birthdate

CPT® Codes with Modifier

ICD-10-CM Other Diagnosis Codes

ICD-10-CM Principal Diagnosis Code

Outpatient Encounter Date

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Some hospitals may prefer to gather data concurrently by identifying patients in the population of interest. This approach provides opportunities for improvement at the point of care/service. However, complete documentation includes the principal or other ICD-10 diagnosis and CPT procedure codes, which require retrospective data entry.

Data Accuracy: Variation may exist in the assignment of ICD-10 and CPT codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: None

Sampling: Yes. Please refer to the measure set specific sampling requirements and for additional information see the Population and Sampling Specifications Section.

Data Reported As: Aggregate rate generated from count data reported as a proportion. Proportion for hip replacements, proportion for knee replacements and aggregated proportion for hip & knee replacements

Selected References:

American Association of Hip and Knee Surgeons. (2015). Patient reported outcomes summit for total joint arthroplasty report. https://www.aahks.org/wp-content/uploads/2015/09/AAHKS-2015-Outcomes-Summit-Report.pdf
Ayers, D. C. (2017). Implementation of patient-reported outcome measures in total knee arthroplasty. Journal of the American Academy of Orthopaedic Surgeons, 25 (Suppl. 1), S48–S50. https://doi.org/10.5435/JAAOS-D-16-00631
Centers for Medicare & Medicaid Services. (2025a). Hospital inpatient quality reporting program. https://www.cms.gov/medicare/quality/initiatives/hospital-quality-initiative/inpatient-reporting-program
Centers for Medicare & Medicaid Services. (2025b). Risk-standardized patient-reported outcome-based performance measure (PRO-PM) following elective primary total hip arthroplasty (THA) and/or total knee arthroplasty (TKA) in the HOPD setting (THA/TKA PRO-PM) (OP-42) (Version 1.0). QualityNet. https://qualitynet.cms.gov/files/6766d395a9dd1a5308128737?filename=HOQR_THATKA_PRO-PM_MIF_v.1.pdf
Centers for Medicare & Medicaid Services. (2026a). Ambulatory surgical center quality reporting program. https://www.cms.gov/medicare/quality/initiatives/asc-quality-reporting
Centers for Medicare & Medicaid Services. (2026b). Hospital outpatient quality reporting program. https://www.cms.gov/medicare/quality/initiatives/hospital-quality-initiative/hospital-outpatient-quality-reporting-program
Centers for Medicare & Medicaid Services. (2026c). TEAM (Transforming episode accountability model). https://www.cms.gov/priorities/innovation/innovation-models/team-model
Pasqualini, I., Elmenawi, K. A., Khan, S. T., Gudapati, L. S., & Piuzzi, N. S. (2026). Implementing the total hip and knee arthroplasty patient-reported outcome-based performance measure in outpatient and ambulatory surgical center settings: A practical review of new Centers for Medicare and Medicaid Services policies. The Journal of Arthroplasty, 41 (3), 668–673. https://doi.org/10.1016/j.arth.2025.10.023

Measure Algorithm:
Graphic depiction of the Measure Algorithm. Refer to the Algorithm Narrative for each detailed step.

THKR-OP-4: Algorithm Narrative

THKR-OP-4: Outpatient Preoperative Functional/Health Status Assessment

Numerator: Patients who completed the general health (VR-12 or PROMIS- Global) AND joint specific functional status assessments (HOOS Jr./subscales or KOOS Jr./subscales) within 90 days prior to surgery.
Denominator: Patients undergoing elective total hip or total knee replacement.

Variable Key: Initial Assessment Day

Stratification Table:

Measure ID	Stratified Measure Name
THKR-OP-4a	Overall Rate
THKR-OP-4b	Hip
THKR-OP-4c	Knee

1. Run cases, which are included in the THKR Outpatient Initial Patient Population and pass the edits defined in the Clinical Data Processing Flow, through this measure.

2. Check ICD-10-CM Principal or Other Diagnosis Codes.

If at least one of the ICD-10-CM Principal or Other Diagnosis Codes is on 14.10, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Proceed to Step 8.
If all ICD-10-CM Principal or Other Diagnosis Codes are missing or none of them on Table 14.10, continue processing and proceed to check CPT® Code Procedure Date.

3. Check CPT® Code Procedure Date.

If CPT® Code Procedure Date is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 8.
If CPT® Code Procedure Date equals UTD, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Proceed to Step 8.
If CPT® Code Procedure Date equals Non-UTD value, continue processing and proceed to check Preoperative Assessments Completed.

4. Check Preoperative Assessments Completed.

If Preoperative Assessments Completed is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 8.
If Preoperative Assessments Completed equals N, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Proceed to Step 8.
If Preoperative Assessments Completed equals Y, continue processing and proceed to check Preoperative Assessments Completion Date.

5. Check Preoperative Assessments Completion Date.

If Preoperative Assessments Completion Date is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Proceed to Step 8.
If Preoperative Assessments Completion Date equals UTD, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Proceed to Step 8.
If Preoperative Assessments Completion Date equals non-UTD value, continue processing and proceed to calculate Initial Assessment Day.

6. Calculate Initial Assessment Day. Initial Assessment Day, in days, is equal to CPT® Code Procedure Date minus Preoperative Assessments Completion Date, continue processing and proceed to check Initial Assessment Day.

7. Check Initial Assessment Day.

If Initial Assessment Day is less than 0 day(s) or greater than 90 days, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Proceed to Step 8.
If Initial Assessment Day is greater than or equal to 0 and less than or equal to 90 days, the case will proceed to a Measure Category Assignment of E and will be in the Numerator Population. Proceed to Step 8.

8. Initialize the Measure Category Assignment for each strata measure (b-c) equals to B. Do not change the Measure Category Assignment that was already calculated for the overall rate (THKR-OP-4a). Proceed to check Overall Rate Category Assignment.

9. Check Overall Rate Category Assignment.

If Overall Rate Category Assignment equals B, assign B to Measure Category Assignment for measures THKR-IP-04b and THKR-OP-04c. Stop Processing.
If Overall Rate Category Assignment equals D, E or X, continue processing and proceed to check CPT® Codes with Modifier.

10. Check CPT® Codes with Modifier.

If CPT® Codes with Modifier is on Table 14.01b, 14.03b, set Measure Category Assignment for measure THKR-OP-04b equal to Measure Category Assignment of THKR-OP-04a. Stop processing.
If CPT® Codes with Modifier is on Table 14.02b, 14.04b, set Measure Category Assignment for measure THKR-OP-04c equal to Measure Category Assignment of THKR-OP-04a. Stop processing.

Specifications Manual for Joint Commission National Quality Measures (v2027A)
Discharges 01-01-2027 (1Q27) through 06-30-2027 (2Q27)

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