Check Your Final 2019 MIPS Eligibility Status

Your eligibility status may have changed for the Merit-based Incentive Payment System (MIPS). Check the Quality Payment Program Participation Status Tool to view your final 2019 eligibility status:

  • Your initial eligibility status was based on review of Medicare Part B claims and Provider Enrollment, Chain and Ownership System (PECOS) data from Oct. 1, 2017, to Sept. 30, 2018
  • We updated your status based on a second review of Medicare Part B claims and PECOS data from Oct. 1, 2018, to Sept. 30, 2019

MIPS Low-Volume Threshold Criteria for 2019

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 (Oct. 1, 2017 – Sept. 30, 2018, or Oct. 1, 2018 – Sept. 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.