MIPS archive

Eligibility criteria

The low volume threshold remains the same as in 2023 and includes three aspects of covered professional services:

1. Allowed charges

2. Number of Medicare patients who receive services

3. Number of services provided

You must participate in MIPS (unless otherwise exempt) if, in both 12-month segments of the MIPS Determination Period, you:

• Bill more than $90,000 for Part B covered professional services, and

• See more than 200 Part B patients, and;

• Provide 200 or more covered professional services to Part B patients.

The opt-in policy also remains the same. It allows physicians or groups who meet one or two of the low-volume threshold criteria to opt-in to participate in MIPS and receive a final score and payment adjustment.

Payment adjustment

The 2024 performance period payment adjustment remains at 9% applied to reimbursements in 2026.

Minimum threshold

Minimum points needed to avoid penalty: 75 points (no change since 2023).

Maximum threshold

The additional performance threshold for exceptional performance was eliminated in 2023, and this continues in 2024. The 2022 performance year was the last year clinicians could earn an exceptional performance bonus. 

MIPS category breakdowns

Quality: 30% of MIPS score

• No change in category weight from 2023.

• Total of 198 quality measures available for the 2024 performance period.

• Data completeness remains at 75% through the 2026 performance period.

  • Small practices (15 providers or fewer) receive 3 points for not meeting data completeness.

  • Large practices (16 providers or more) receive 0 points for not meeting data completeness.

• Performance period: Jan. 1 – Dec. 31, 2024.

• Submission methods: claims (for small practices), registry, QCDRs such as the Academy’s 

  DataDerm^™, which may integrate with your practice’s EHR.

Improvement Activities (IA): 15% of MIPS score

• No change in category weight from 2023.

• Medium- and high-weighted activities available.

• Performance period: 90-day continuous performance period between Jan. 1 – Dec. 31, 2024.

• Added five new activities, modified one existing, and removed three existing improvement activities.

• Group participation threshold remains the same as in 2023 (50% of participation of eligible clinicians in group).

• Submission methods: CMS or QCDR.

Promoting Interoperability (PI): 25% of MIPS score

• No change in category weight from 2023.

• Performance period: continuous 180-days between Jan. 1 – Dec. 31, 2024, up from 90-days in previous years.

• Submission methods: registry, QCDRs, EHRs.

• CMS revised the definition of CEHRT to align with the Office of National Coordinator for Health IT (ONC)’s regulations. You can check your EHR on the Certified Health IT Product List (CHPL) site to ensure it has been successfully tested and certified by the ONC Health IT Certification program.

• Measure updates (PI scoring remains the same from 2023):

  • Modification to the PDMP measure exclusion to include those providers who do not prescribe Schedule II opioids and Schedule III and IV drugs during the performance period.

  • Modification to the Safety Assurance Factors for EHR Resilience (SAFER) measure to require MIPS eligible clinicians to conduct a self-assessment annually, and attest a “yes” response, accounting for completion of the self-assessment for the High Priority Practices SAFER Guide. For help with your self-assessment for the SAFER measure, use these guidelines on using SAFER.

  • The e-prescribing measure will have a technical update. The measure description revision does not affect those clinicians reporting and submitting the measure.

• CMS has discontinued PI automatic reweighing for nurse practitioners, physician assistants, certified nurse anesthetists, and clinical nurse specialists (no change from 2023).

• For the Public Health and Clinical Data Exchange Objective, MIPS eligible clinicians (ECs) must submit their level of active engagement, either Pre-production and Validation or Validated Data Production for each measure they report under this objective (no change from 2023).

Cost: 30% of MIPS score

• No change from 2023.

• No action required by eligible clinician.

Scoring

The overall scoring methodology for each category remains the same as 2023.

Reporting type

Individual: Under an NPI number and TIN where they reassign benefits; report via claims, registry, or EHR.

Group: Two or more clinicians (by NPIs) who have reassigned their billing rights to a single TIN; report via claims, registry, or EHR.

• Small practices, excluding those participating in MIPS as part of a virtual group, must submit data as a group in any performance category to indicate that they wish to be scored as a group for Medicare Part B claims.

Small practice accommodations

Accommodations for small practices include:

• 3 points for measures that do not meet data completeness of 75%.

• Claims-based reporting available.

• 6 bonus points added to numerator of Quality category.

• Automatic redistribution of the PI category weight for any small practice that does not submit data for PI.

MIPS Value Pathways (MVPs)

The option to participate in an MVP began in 2023. There are 16 MVPs available for voluntary reporting in 2024, including 5 revised ones from 2023.

ECs may participate in MVPs via subgroups which is a subset of a group that contains at least one MIPS EC and is identified by a combination of the group TIN, the subgroup identifier, and each EC’s NPI.

Extreme and uncontrollable circumstances (EUCs)

CMS will align EUCs with extraordinary circumstance exceptions (ECE) for automatic application when appropriate. Application-based EUCs are also available as needed.

Telehealth

• Telehealth services furnished to people in their homes will be paid at the non-facility MPFS rate beginning in the 2024 PY.

• Modification to the existing telehealth indicator policy on clinician profile pages. CMS will display the most up to date POS and claims modifier codes available at the time the information is refreshed on the clinician profile pages.

Telehealth policies CMS is reviewing and finalizing following 2024 (policies in place until Dec. 31, 2024):

• Continue to allow Medicare telehealth services to be furnished to patients located anywhere within the U.S., including an individual’s home.

• Continued payment for telehealth services furnished by RHCs and FQHCs using the methodology established for those telehealth services during the COVID-19 PHE.

• Continued coverage and payment of telehealth services included on the Medicare Telehealth Services List through 2024.

• Continue to allow teaching physicians to use audio/visual real-time communication technology to be present when the resident furnishes Medicare telehealth services in all residency training locations through the end of 2024; teaching physicians and residents do not have to be co-located.

• Continue to allow direct supervision by a supervising practitioner through real-time audio and video interaction telecommunications through 2024.

• Continue to allow clinicians who render telehealth services from their homes to list their practice address instead of their home address on their Medicare enrollment through 2024.

Additional information

• Review a full CMS description of the 2024 changes.

• Access the entire 2024 Medicare Physician Fee Schedule Final Rule (PDF).

Related Academy resources