Quality Payment Program: MIPS Low-Volume Threshold Criteria for 2019

The Centers for Medicare & Medicaid Services (CMS) added a third low-volume threshold criterion for determining Merit-based Incentive Payment System (MIPS) eligibility for 2019. Clinicians and groups are excluded from MIPS if they:

• Billed $90,000 or less in Medicare Part B allowed charges for covered professional services during either of the two determination periods (October 1, 2017–September 30, 2018, or October 1, 2018–September 30, 2019)
• Provided care to 200 or fewer Part B-enrolled patients during either of the two determination periods
• New for 2019: Provided 200 or fewer covered professional services under the Physician Fee Schedule during either of the two determination periods

In order to be eligible for MIPS, a clinician or group must exceed all three criteria listed above. Check the Quality Payment Program Participation Status Tool to view your final 2019 eligibility status for MIPS. 

Clinicians and groups who are not eligible for MIPS can still choose to report data to MIPS through the opt-in or voluntary reporting options.

For more information:

• Reporting Options Overview Webpage
• 2019 MIPS Opt-In Reporting and Election Process Toolkit
• Contact QPP@cms.hhs.gov or 866-288-8292 (TTY: 877-715-6222)