PPS: Who is eligible to Participate in MIPS?

MIPS-Eligible Clinicians

Eligible clinicians during the 2017 reporting year include physicians (including psychiatrists), nurse practitioners, physician assistants, clinical nurse specialists and nurse anesthetists who bill Medicare Part B using the physician fee schedule.

In 2017, MIPS does NOT apply to:

• Clinical psychologists & licensed clinical social workers (LCSWs)
• First-year Medicare providers
• Qualifying Advanced APM clinicians
• Hospitals and facilities (e.g., skilled nursing facilities) that do not bill medicare using the Physician Fee Schedule
• Clinicians [or groups] who fall beneath CMS’s low-volume threshold, who serve fewer than 100 Medicare recipients OR bill Medicare $30,000 or less per year
• Clinicians and groups who are not paid under the Physician Fee Schedule (e.g., FQHCs and partial hospitalization programs); MIPS also does not apply to Managed Care payments

Although they are not considered eligible in 2017, the final rule states that additional clinicians, including psychologists and LCSWs, may be eligible to report to MIPS in 2019.

Am I included in MIPS?

Use CMS's online tool to check if you need to submit data to MIPS


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The National Council for Behavioral Health - MIPS Resource Guide (PDF)

The content of this article is reproduced with explicit permission from the National Council for Behavioral Health. The content was retrieved on November 18, 2016. Please visit the National Council for Behavioral Health for updated materials. 

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