Enter up to 100 relevant 10-digit National Provider Identifier (NPI) numbers to view their Quality Payment Program participation status for the selected performance year. QPP Participation Status for eligible clinicians includes MIPS eligibility as well as APM participation.
Please note this tool is a technical resource and doesn’t officially determine eligibility for any clinician, group, or organization.
MIPS Participation
Level
Practice Name
Eligible
Reason(s)
Other Factors
APM Participation
Classification
Practice Name
Model
Who is considered a MIPS-eligible clinician?
Eligible clinician types:
Physicians
Osteopathic practitioners
Chiropractors
Physician assistants
Nurse practitioners
Clinical nurse specialists
Certified registered nurse anesthetists
Physical therapists
Occupational therapists
Clinical psychologists
Qualified speech-language pathologists
Qualified audiologists
Registered dietitians or nutrition professionals
Clinical social workers
Certified nurse midwives
The Low-volume threshold: Otherwise eligible clinicians or groups are exempt from MIPS reporting if they:
Bill ≤ $90,000
Or provide care for ≤ 200 Medicare Part B patients
Or have ≤ 200 covered professional services.
They may opt-in or voluntarily report under certain circumstances to participate in the incentive program or monitor their performance for other reasons.
Other possible exemptions
Newly enrolled in Medicare: If a clinician enrolls in Medicare in the middle of a performance year, they don’t have to participate in MIPS reporting that year. For example, if a clinician enrolled in Medicare on Feb. 6, 2025, they would be exempt for the 2025 performance year (Jan. 1-Dec. 31, 2025).
Advanced APM participation: If a clinician enrolls in Medicare in the middle of a performance year, they don’t have to participate in MIPS reporting that year. For example, if a clinician enrolled in Medicare on Feb. 6, 2025, they would be exempt for the 2025 performance year (Jan. 1-Dec. 31, 2025).
Clinicians participating in Advanced APMs
For 2025, if you have a certain percentage of your Part B payments through an Advanced APM or see a certain percentage of your patients through an Advanced APM, you won’t have to submit data to MIPS.
During the QPP Performance Year, CMS takes 4 snapshots to see which Advanced APM participants meet the thresholds to become Qualifying APM Participants (QPs).
If you participate in Advanced APMs but don’t meet the threshold, you may become a Partial QP. Partial QPs can choose if they want to participate in MIPS.
Low-volume threshold for APMs
For eligible clinicians participating in MIPS APMs, the low-volume threshold (LVT) is calculated at the APM entity level, also referred to as the ACO level.
This means that even if a clinician or group is at or below the LVT of $90,000 in covered professional services under the Medicare PFS, or furnishing covered professional services to fewer than or equal to 200 beneficiaries, if they participate in a MIPS APM, they will be subject to MIPS if the APM Entity exceeds the LVT.
Eligibility review periods
CMS reviews your eligibility twice times during the performance year.
Eligibility review dates
CMS completed the first eligibility review in December 2024 by examining claims from Oct. 1, 2023- Sept. 30, 2024. CMS reviewed Medicare Part B Claims data and PECOS data, and will only apply it to PY 2024.
CMS will complete a second eligibility review by examining Medicare Part B Claims data from Oct. 1, 2024-Sept. 30, 2025 and PECOS data. If you join a new practice during this time period, your eligibility under that practice was evaluated during the second review. Check your final status with our online MIPS eligibility tool.
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