MIPS

Eligibility & Exemptions

Are you a MIPS Eligible Clinician?

Compared to the current CMS quality initiatives, the pool of eligible clinicians (formerly called eligible providers) will be shrinking significantly for the 2019 performance year. This year (2023) the pool of eligible clinicians has expanded, and the payment adjustment remains at 9%.

Performance Year

Adjustment Year

MIPS Eligible Clinicians

2023

2025

Physicians (including doctors of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, and optometry), Chiropractors, Osteopathic practitioners, 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.

Possible Exemptions for MIPS Eligible Clinicians

1. MIPS Low-Volume Threshold (Must meet all three criteria to be eligible for MIPS)

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

See more than 200 Part B patients.

Provide more than 200 covered professional services to Part B patients.

2. Newly Enrolled in Medicare

If a clinician enrolls in Medicare in the middle of a performance year, they do not have to participate in MIPS reporting that year. For example, if a clinician was to enroll in Medicare on February 6, 2023, they will be exempt for the 2023 performance year (January 1, 2023- December 31, 2023).