We are preparing 2026 MIPS quality reporting for a solo radiologist in a small practice who specializes exclusively in breast imaging and breast biopsies. In a prior Exception denial response (December 2025), CMS listed the following measures as applicable: 358, 360, 364, 405, 406. We are using these measures to guide our 2026 setup, but we have concerns about denominator volume and scoring. 

Measure 406: Although CPT 71250 was billed more than 600 times in the past year, only one patient met denominator criteria. If we report Denominator = 1 and Numerator = 1: Would this score as 100% (10 points)? Is there a minimum case requirement (e.g., 20 cases)? Would this be suppressed or scored as zero due to low volume? 

Measure 405: This radiologist specializes solely in breast imaging and does not encounter incidental abdominal lesions. We identified zero denominator cases. If Denominator = 0, does this measure count toward the six required quality measures? Does it generate any score contribution? 

Measure 364 (CQM, not eCQM): We are seeing similarly low denominator volume and request clarification on scoring expectations for rare incidental findings. 

Given that this clinician practices exclusively breast imaging and diagnostic breast procedures, could you advise which six quality measures (eCQMs preferred for our current reporting capabilities) would be considered most appropriate and meaningful for her scope of practice? We want to ensure our 2026 reporting aligns with CMS expectations while reflecting her true clinical focus.

I have no idea what option to choose below where we have to choose something other than None. We are a small practice, not a hospital.