AAO32: Standard Benign Positional Paroxysmal Vertigo (BPPV) Management+

High Priority Status: Yes / Appropriate Use

NQF Number: N/A

Measure Description:

Percentage of patients diagnosed with Benign Positional Paroxysmal Vertigo (BPPV) who received vestibular testing, imaging, and antihistamine or benzodiazepine medications.

Instructions:

This measure is to be submitted a minimum of once per performance period for patients diagnosed with benign positional paroxysmal vertigo. This measure may be submitted by clinicians based on the services provided and the measure-specific denominator coding.

Denominator:

All patients diagnosed with posterior canal BPPV.

Denominator Note:

To meet the denominator criteria, a patient a diagnosis of BPPV must be documented during the encounter.

Denominator Exclusions:

Patients whose diagnosis of BPPV was made after vestibular testing, imaging, or antihistamine, benzodiazepine, or vestibular suppressant medications were prescribed are not included in the eligible population for the denominator.

 Denominator Criteria:

All patient ages

AND

Diagnosis: BPPV

AND

Patient Visit: Encounter Visit

AND NOT

            Diagnosis: BPPV

AND

History of Prior: Vestibular Testing or Imaging

OR

Current Prescription for: Antihistamine, Benzodiazepine, or Vestibular Suppressant

For a list of codes that qualify as denominator eligible visits, reference Addendum attached.

Numerator:

1. Patients with BPPV referred for vestibular testing by the encounter provider
2. Patients with BPPV referred, recommended, or ordered a CTA, CT, MRA, or MRI by the encounter provider
3. Patients with BPPV prescribed antihistamine, benzodiazepine, or vestibular suppressant medications by the encounter provider
4. Total patient performance on the 3 above components (Any-or-nothing calculation).

Numerator Note:

Numerator component D: Total patient performance on the 3 above components (Any-or-nothing calculation) is used for MIPS scoring purposes.

INVERSE MEASURE – A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.

Denominator Exceptions:

For numerator component A, patients may be excluded if they have:

• Negative Dix-Hallpike maneuver
• Dizziness that lasts longer than one minute
• Postural or gait abnormalities
• Transient dizziness that is unresponsive to repositioning

For numerator component B, patients may be excluded if they have:

• Atypical BPPV (anterior canal, relapsing BPPV, BPPV associated with other neurological conditions, or severe multi-canal BPPV)
• Focal deficit or unilateral hearing loss
• Vision changes
• Trauma history
• Recent surgery

For numerator component C, patients may be excluded if they have:

• Patient refuses other treatment options
• Severe symptoms during positioning
• Nausea or vomiting during positioning
• Patient requires prophylaxis
• Clinical indication for long-term use present (e.g., anxiety disorder)

Measure Classifications:

• Submission Pathway: Traditional MIPS
• Measure Type: Process
• High Priority Type: Appropriate Use
• Meaningful Measures Area: Appropriate Use of Healthcare
• Care Setting(s): Ambulatory Care: Clinician Office/Clinic
• Includes Telehealth: Yes
• Number of Performance Rates: 1
  • Inverse measure: Yes
  • Continuous measure: No
  • Proportional measure: Yes
  • Ratio measure: No
  • Risk Adjusted measure: No

Clinical Recommendation Statement:

Clinicians should not obtain radiographic imaging in a patient who meets diagnostic criteria for BPPV in the absence of additional signs and/or symptoms inconsistent with BPPV that warrant imaging. Clinicians should not order vestibular testing in a patient who meets diagnostic criteria for BPPV in the absence of additional vestibular signs and/or symptoms inconsistent with BPPV that warrant testing. Clinicians should not routinely treat BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines.

 Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology Head Neck Surg. 2017;156(3_suppl):S1-S47. doi:10.1177/0194599816689667

Rationale:

Implementation of this measure provides an opportunity to reduce delays in BPPV diagnosis and treatment, reduce the use of low-value, high-cost studies, and reduce unwarranted variation in care.

Supporting Clinical Practice Guideline (CPG):

For more details, reference the Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) [2017]

© 2026 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved.

Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g. use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the measures for commercial gain, or incorporation of the measures 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 Otolaryngology – Head and Neck Surgery Foundation.

The measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The measure and specifications are provided “as is” without warranty of any kind. Neither the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF), nor its members shall be responsible for any use of the measure. The AAO-HNSF and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT®) or other coding contained in the specifications.

Addendum