MIPS eligibility lookup

MIPS eligibility lookup

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 that this tool is a technical resource only 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?

  1. Eligible clinician types: Physicians (including doctors of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, and optometry), 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, and certified nurse midwives are eligible clinician types.
  2. The Low-Volume Threshold: You’re considered a MIPS-eligible clinician (i.e., required to report) and will receive a payment adjustment when you’re enrolled in Medicare before Jan. 1, 2023, you exceed the Low-Volume Threshold if you bill >$90,000 and provide care for >200 Medicare Part B patients or have >200 covered professional services.

    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.
    • The Low-Volume Threshold: Otherwise eligible clinicians or groups will be 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, if they want to participate in the incentive program or monitor their performance for other reasons.
    • 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.

If you’re exempt from MIPS for the 2023 performance year, you aren’t required to participate. You may opt in or voluntarily report under certain circumstances. You’re encouraged to check your participation eligibility status again at the end of 2023 if you’ve made any changes that may change your eligibility status.

Clinicians participating in Advanced APMs

For the 2023 performance year, 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 performance year, CMS takes 3 snapshots (on March 31, June 30, and Aug. 31) 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 ECs 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 Low-Volume Threshold of $90,000 in covered professional services under the Medicare PFS, or furnishing covered professional services to less 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 Low-Volume Threshold.

Eligibility review periods

For the 2022 performance year, your eligibility was reviewed at 2 different times during the performance year.

Eligibility review dates

For the 2023 performance year, the initial eligibility review was completed in December 2022 by examining claims from Oct. 1, 2021-Sept. 30, 2022. CMS reviewed Medicare Part B Claims data and PECOS data and will only apply it to the 2023 performance year.

CMS completed a final eligibility review by examining Medicare Part B Claims data from Oct. 1, 2022-Sept. 30, 2023 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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