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How do I know if I have to report MIPS?

The first step for anyone with questions regarding MIPS is to check your eligibility, also known as, reporting requirements.
  1. Step 1: Lookup Eligibility
  1. Step 2: Interpreting Eligibility
  • Once practices find the Associated Practice that is using Elation, there are three possible outcomes, only one of which requires practices to participate in MIPS (see below).
Three MIPS eligibility scenarios: 1) Both INDIVIDUAL and GROUP eligible (highlighted): required to participate, submit as either for higher score. 2) INDIVIDUAL ineligible, GROUP eligible: individual not required, group optional. 3) Both ineligible: not required, no payment adjustment.
Eligibility Note : if you or your practice are associated with and participating in an APM (ACO or other APM type) contact the APM administrator to determine best practices for MIPS participation and data submission. MIPS APM participation may vary from traditional MIPS participation. MIPS data and quality data are generally submitted via the APM and that is important to understand.
This is a logic determination visual shared by CMS: 2025 MIPS Eligibility Decision Tree flowchart from CMS showing sequential yes/no questions: MIPS-eligible clinician type → enrolled in Medicare after 1/1/25 → meets low-volume threshold → Qualifying APM Participant → Partial QP. Outcomes include: not eligible, excluded from MIPS, may choose whether to participate, or required to participate and subject to MIPS Final Score payment adjustment. Sidebar lists eligible clinician types and 2025 low-volume threshold criteria (over $90,000 Part B charges, over 200 Medicare Part B patients, over 200 covered professional services). All of this information is based on regulatory statue with this eligibility determination.

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Which Clinician Types are eligible for MIPS?

The following Clinician Types are eligible for MIPS:
  • Physicians (MD, DO, DDS, DMD, DPM, OD)
  • Osteopathic practitioners
  • Chiropractors
  • Physician assistants
  • Nurse practitioners
  • Clinical Nurse Specialists
  • Certified 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
  • Clinical nurse specialists

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Which exceptions exempt me from MIPS reporting?

If any of the following apply to the provider, they are not required to participate in MIPS:
  • Fewer than 200 Medicare fee-for-service patients
  • Less than $90,000 in Medicare charges
  • Fewer than 200 Medicare fee schedule services
  • Participate in an Advanced APM
  • First-year Medicare provider

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Who can I speak to about my MIPS Eligibility?

For questions regarding eligibility specifically, please contact the QPP helpdesk for further support. The QPP helpdesk is the support center for all things related to MIPS and provides the best support. QPP helpdesk
  • Hours: Monday - Friday 8 a.m - 8 p.m Eastern Time
  • Phone: 1-866-288-8292 (TRS: 711)
  • Email: QPP@cms.hhs.gov

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What are the additional resources I can reference?