High Priority Status: Yes / Appropriate Use
CBE Number: N/A
Measure Description:
Percentage of patients aged 1 year and older who underwent an otolaryngologic surgical procedure and did not receive perioperative or postoperative antibiotics when there were no clinical indications, based on evidence-based guidelines.
Instructions:
This measure is to be submitted each time a patient underwent an otolaryngologic surgical procedure during the performance period. This measure may be submitted by clinicians based on the services provided and the measure-specific denominator coding.
Denominator:
Patients aged 1 year and older who underwent an otolaryngologic surgical procedure where antibiotic prophylaxis is not recommended based on evidence and/or clinical guidelines
Denominator Exclusion:
Procedures involving extensive tissue disruption or placement of implants or hardware (e.g., cochlear implants or trauma cases)
Denominator Criteria:
Patients aged 1 year and older
AND
Procedure: Otolaryngologic surgical procedures where antibiotic prophylaxis is not recommended
AND NOT
Procedure: Extensive tissue disruption or placement of implants or hardware
For a list of codes that qualify as denominator eligible visits, reference Addendum attached.
Numerator:
Patients who did not receive perioperative or postoperative antibiotics
Denominator Exceptions:
Documentation of a medical reason for administering antibiotics (i.e., active infection, immunocompromised patient, etc.)
Measure Classifications
- Submission Pathway: Traditional MIPS
- Measure Type: Process
- High Priority Type: Appropriate Use
- Care Setting(s): Ambulatory; Ambulatory Care: Clinician Office/Clinic; Ambulatory Care: Hospital; Ambulatory Surgical Center; Hospital Outpatient; Office Based Surgery Center; Outpatient Services
- Includes Telehealth: No
- Number of Performance Rates: 1
- Inverse measure: No
- Continuous measure: No
- Proportional measure: Yes
- Ratio measure: No
- Risk Adjusted measure: No
Clinical Recommendation Statement:
Several high-quality guidelines and systematic reviews recommend against the routine use of perioperative antibiotics for many common otolaryngology surgical procedures, particularly those classified as clean or low-risk. The American Academy of Otolaryngology–Head and Neck Surgery and the Infectious Diseases Society of America both strongly recommend against routine perioperative antibiotics for tonsillectomy in children, citing high-level evidence that antibiotics do not reduce postoperative morbidity, pain, or bleeding, and emphasizing the importance of antimicrobial stewardship. Similarly, the Infectious Diseases Society of America guideline states that antibiotic prophylaxis is not recommended for clean head and neck procedures such as thyroidectomy, parathyroidectomy, and salivary gland excisions, as well as for tonsillectomy, adenoidectomy, septoplasty, and endoscopic sinus surgery, due to lack of benefit in reducing surgical site infections.
Bratzler, D. W., Dellinger, E. P., Olsen, K. M., et al. (2013). Clinical practice guidelines for antimicrobial prophylaxis in surgery. American Journal of Health-System Pharmacy, 70(3), 195–283. https://doi.org/10.2146/ajhp120568
Mitchell, R. B., Archer, S. M., Ishman, S. L., et al. (2019). Clinical practice guideline: Tonsillectomy in children (update). Otolaryngology–Head and Neck Surgery, 160(1_suppl), S1–S42. https://doi.org/10.1177/0194599818801757
Rationale:
Recent studies highlight that, for example, up to 83% of patients undergoing clean ENT surgeries in some settings receive antibiotics unnecessarily, and prolonged courses are common even when a single perioperative dose (or none) is indicated. Tonsillectomy in children is a particularly well-documented example, with historical prescribing rates as high as 79% despite strong evidence and guideline recommendations against routine perioperative antibiotics.[4] Similarly, clean head and neck surgeries (e.g., thyroidectomy, parathyroidectomy) and clean otologic procedures (e.g., tympanoplasty, stapedectomy) are often subject to unnecessary antibiotic use. In summary, the highest rates of inappropriate antibiotic prescribing are seen in clean otolaryngology procedures where guidelines recommend against prophylaxis, with tonsillectomy, adenoidectomy, septoplasty, thyroidectomy, and parathyroidectomy being the most prominent examples.
Bratzler, D. W., Dellinger, E. P., Olsen, K. M., et al. (2013). Clinical practice guidelines for antimicrobial prophylaxis in surgery. American Journal of Health-System Pharmacy, 70(3), 195–283. https://doi.org/10.2146/ajhp120568
Mitchell, R. B., Archer, S. M., Ishman, S. L., et al. (2019). Clinical practice guideline: Tonsillectomy in children (update). Otolaryngology–Head and Neck Surgery, 160(1_suppl), S1–S42. https://doi.org/10.1177/0194599818801757
Patel, P. N., Jayawardena, A. D. L., Walden, R. L., Penn, E. B., & Francis, D. O. (2018). Evidence-based use of perioperative antibiotics in otolaryngology. Otolaryngology–Head and Neck Surgery, 158(5), 783–800. https://doi.org/10.1177/0194599817753610
Yalamanchi, P., Parent, A., & Thorne, M. (2020). Optimization of delivery of pediatric otolaryngology surgical antibiotic prophylaxis. Otolaryngology–Head and Neck Surgery, 163(2), 275–279. https://doi.org/10.1177/0194599820933191
Oppelaar, M. C., Zijtveld, C., Kuipers, S., et al. (2019). Evaluation of prolonged vs short courses of antibiotic prophylaxis following ear, nose, throat, and oral and maxillofacial surgery: A systematic review and meta-analysis. JAMA Otolaryngology–Head & Neck Surgery, 145(7), 610–616. https://doi.org/10.1001/jamaoto.2019.0879
© 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 specification.
Addendum
| Otolaryngologic Surgical Procedures |
| Measure Element | Code Type | Code | Code Description |
| Denominator | CPT | 42825 | Tonsillectomy primary/secondary; younger than age 12 |
| Denominator | CPT | 42826 | Tonsillectomy primary/secondary; age 12 or over |
| Denominator | CPT | 42830 | Adenoidectomy primary; younger than age 12 |
| Denominator | CPT | 42831 | Adenoidectomy primary; age 12 or over |
| Denominator | CPT | 42835 | Adenoidectomy secondary; younger than age 12 |
| Denominator | CPT | 42836 | Adenoidectomy secondary; age 12 or over |
| Denominator | CPT | 42820 | Tonsillectomy and adenoidectomy; younger than age 12 |
| Denominator | CPT | 42821 | Tonsillectomy and adenoidectomy; age 12 or over |
| Denominator | CPT | 30520 | Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft |
| Denominator | CPT | 30400 | Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip |
| Denominator | CPT | 31253 | Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed |
| Denominator | CPT | 31254 | Nasal/sinus endoscopy, surgical with ethmoidectomy; partial (anterior) |
| Denominator | CPT | 31255 | Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior) |
| Denominator | CPT | 31267 | Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus |
| Denominator | CPT | 31276 | Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performed |
| Denominator | CPT | 31287 | Nasal/sinus endoscopy, surgical, with sphenoidotomy; |
| Denominator | CPT | 31288 | Nasal/sinus endoscopy, surgical, with sphenoidotomy; with removal of tissue from the sphenoid sinus |
| Denominator | CPT | 69436 | Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
| Denominator | CPT | 69433 | Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia |
| Denominator | CPT | 69631 | Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction |
| Denominator | CPT | 69632 | Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction (eg, postfenestration) |
| Denominator | CPT | 69633 | Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP]) |
| Denominator | CPT | 69635 | Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); without ossicular chain reconstruction |
| Denominator | CPT | 69636 | Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction |
| Denominator | CPT | 69637 | Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP]) |
| Denominator | CPT | 69641 | Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); without ossicular chain reconstruction |
| Denominator | CPT | 69642 | Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with ossicular chain reconstruction |
| Denominator | CPT | 69643 | Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, without ossicular chain reconstruction |
| Denominator | CPT | 69644 | Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed canal wall, with ossicular chain reconstruction |
| Denominator | CPT | 69645 | Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, without ossicular chain reconstruction |
| Denominator | CPT | 69646 | Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, with ossicular chain reconstruction |
| Denominator | CPT | 69620 | Myringoplasty (surgery confined to drumhead and donor area) |
| Denominator | CPT | 69660 | Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or without use of foreign material; |
| Denominator | CPT | 69661 | Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or without use of foreign material; with footplate drill out |
| Denominator | CPT | 69501 | Transmastoid antrotomy (simple mastoidectomy) |
| Denominator | CPT | 69502 | Mastoidectomy; complete |
| Denominator | CPT | 69505 | Mastoidectomy; modified radical |
| Denominator | CPT | 69511 | Mastoidectomy; radical |
| Denominator | CPT | 60220 | Total thyroid lobectomy, unilateral; with or without isthmusectomy |
| Denominator | CPT | 60225 | Total thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy |
| Denominator | CPT | 60240 | Thyroidectomy, total or complete |
| Denominator | CPT | 60252 | Thyroidectomy, total or subtotal for malignancy; with limited neck dissection |
| Denominator | CPT | 60254 | Thyroidectomy, total or subtotal for malignancy; with radical neck dissection |
| Denominator | CPT | 60500 | Parathyroidectomy or exploration of parathyroid(s) |
| Denominator | CPT | 60502 | Parathyroidectomy or exploration of parathyroid(s); re-exploration |
| Denominator | CPT | 60505 | Parathyroidectomy or exploration of parathyroid(s); with mediastinal exploration, sternal split or transthoracic approach |
| Denominator | CPT | 42440 | Excision of submandibular (submaxillary) gland |
| Denominator | CPT | 42450 | Excision of sublingual gland |
| Denominator | CPT | 42420 | Excision of parotid tumor or parotid gland; total, with dissection and preservation of facial nerve |
| Denominator | CPT | 42425 | Excision of parotid tumor or parotid gland; total, en bloc removal with sacrifice of facial nerve |
| Denominator | CPT | 21555 | Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm |
| Denominator | CPT | 21552 | Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greater |
| Denominator | CPT | 21554 | Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); 5 cm or greater |
| Denominator | CPT | 21556 | Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); less than 5 cm |
| Denominator | CPT | 21557 | Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax; less than 5 cm |
| Denominator | CPT | 21558 | Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax; 5 cm or greater |
| Denominator | CPT | 31545 | Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s) |
| Denominator | CPT | 31546 | Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with graft(s) (includes obtaining autograft) |
| Denominator | CPT | 31551 | Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, younger than 12 years of age |
| Denominator | CPT | 31552 | Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, age 12 years or older |
| Denominator | CPT | 31553 | Laryngoplasty; for laryngeal stenosis, with graft, with indwelling stent placement, younger than 12 years of age |
| Denominator | CPT | 31554 | Laryngoplasty; for laryngeal stenosis, with graft, with indwelling stent placement, age 12 years or older |
| Denominator | CPT | 31571 | Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or telescope |
| Denominator | CPT | 31580 | Laryngoplasty; for laryngeal web, with indwelling keel or stent insertion |
| Denominator | CPT | 31584 | Laryngoplasty; with open reduction and fixation of (eg, plating) fracture, includes tracheostomy, if performed |
| Denominator | CPT | 31587 | Laryngoplasty, cricoid split, without graft placement |
| Denominator | CPT | 31590 | Laryngeal reinnervation by neuromuscular pedicle |
| Denominator | CPT | 31591 | Laryngoplasty, medialization, unilateral |
| Denominator | CPT | 21206 | Osteotomy, maxilla, segmental (eg, Wassmund or Schuchard) |
| Denominator | CPT | 21208 | Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) |
| Denominator | CPT | 42810 | Excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues |
| Denominator | CPT | 42815 | Excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into pharynx |
| Denominator | CPT | 38500 | Biopsy or excision of lymph node(s); open, superficial |
| Denominator | CPT | 38505 | Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary) |
| Extensive Tissue Disruption/Trauma |
| Denominator Exclusion | ICD10CM | S02.92XB | Unspecified fracture of facial bones, initial encounter for open fracture |
| Denominator Exclusion | ICD10CM | S02.81XB | Fracture of other specified skull and facial bones, right side, initial encounter for open fracture |
| Denominator Exclusion | ICD10CM | S02.82XB | Fracture of other specified skull and facial bones, left side, initial encounter for open fracture |
| Denominator Exclusion | ICD10CM | S02.80XB | Fracture of other specified skull and facial bones, unspecified side, initial encounter for open fracture |
| Placement of Implants or Hardware |
| Denominator Exclusion | CPT | 69930 | Cochlear device implantation, with or without mastoidectomy |
| Denominator Exclusion | CPT | 69714 | Implantation, osseointegrated implant, skull; with percutaneous attachment to external speech processor |
