Measure 109 – Osteoarthritis (OA): Function and Pain Assessment

Please note: Measure 109 has been removed from the MIPS CQM measure set for the 2020 performance year.

Audit Criteria

When we’re reviewing your clinicians’ data, it may be helpful to know what we are looking for in order for us to verify to CMS that your data is accurate and complete. Measure 109 requires a diagnosis of osteoarthritis AND an assessment for function and pain.

This documentation may be found in the medical record, physician notes, Empower (if sending surveys through the Empower platform) or another survey platform. The relevant document should be made available to the auditor for the patient requested.


What surveys are indicated for this measure?

This measure requires the use of an assessment for pain AND functional status. Below is a list of survey instruments that can be used to measure these domains. Instruments with a (*) next to them are available to you in AAOE Empower.



  • Visual Analog Scale*
  • PROMIS-10*
  • Numeric Pain Rating System



  • Veterans RAND 12 (VR-12)
  • PROMIS 10*
  • EuroQol-5D (EQ-5D)
  • Foot and Ankle Ability Measure (FAAM)*
  • Foot and Ankle Disability Index (FADI)*
  • International Knee Documentation Committee (IKDC) Subjective Knee Form (Pedi-IKDC)
  • Marx Activity Rating Scale
  • Knee Injury and Osteoarthritis Outcome Score (KOOS)*
  • Knee Injury and Osteoarthritis Outcome Score, Jr. (KOOS Jr.)*
  • Hip Disability and Osteoarthritis Outcomes Survey (HOOS)*
  • Hip Disability and Osteoarthritis Outcomes Survey Jr. (HOOS Jr.)*
  • American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES)*
  • Oxford Shoulder Score (OSS)
  • Single Assessment Numeric Evaluation (SANE)
  • Western Ontario Shoulder Instability Index (WOSI)
  • Disabilities of the Arm, Shoulder, and Hand Score (DASH)*
  • Quick-DASH*