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CMS QPP MIPSCMS Quality Payment Program (MIPS)
U.S. Centers for Medicare and Medicaid Services · Tier-2 · profile-enrichment (renders on matched profiles)
The CMS Quality Payment Program (QPP) Merit-based Incentive Payment System (MIPS) publishes annual composite performance scores for individual clinicians and group practices participating in Medicare Part B. Scores (0–100) span four performance categories — Quality, Cost, Improvement Activities, and Promoting Interoperability — and determine a payment adjustment (positive, neutral, or negative) applied to Medicare reimbursements two years after the performance year.
How this source shows up on Fonteum.
MIPS composite scores and payment adjustments render on individual provider profiles (NPI-matched) with full provenance (source · performance year · methodology version). Powers the brand-hub clinician-quality module and the dbt QPP mart. Data is surfaced as published by CMS; Fonteum does not independently score, weight, or rank clinicians.
What this source does NOT mean
MIPS scores are a Medicare reimbursement-program measure, not a comprehensive measure of clinical quality or patient outcomes. A high MIPS score indicates participation and performance on program-defined measures; it does not evaluate all dimensions of care. Clinicians who opt out, are excluded, or fall below the low-volume threshold are not scored.
Research and data questions this source supports.
- Surface a clinician's composite MIPS score on their provider profile as the first federal quality signal beyond Medicare enrollment.
- Build a specialty-filtered MIPS leaderboard — identify the top-performing cardiologists in a metro by their composite performance score.
- Support payer credentialing with QPP MIPS individual scores as a quality tier signal alongside board certification and PECOS enrollment.
- Run specialty-level quality distributions to benchmark a practice against national and state peer cohorts.
- Power a research surface showing which specialties have the highest concentration of Exceptional performers (composite ≥ 89.01) by performance year.
Dataset size: 477,137 clinician scores (Performance Year 2023)
Per-field display contract.
Every field below has a `display_allowed` flag in the §94 provenance schema. Write-locked fields are captured to provenance for audit but never rendered on profile pages.
Renders on profile
9 fieldsWhat we can’t infer from this source.
- Annual cadence — scores lag performance year by ~12 months (performance year 2024 scores publish ~July 2025).
- ~30% of eligible clinicians excluded or opted out (low-volume threshold, voluntary opt-out, newly enrolled providers).
- Group scores cover practice aggregate, not individual clinician performance within the group.
- MIPS measures change year-to-year; scores are not directly comparable across performance years without cohort flagging.
- Payment adjustment applies to Medicare Part B reimbursements only; no direct bearing on commercial-insurance quality.
Authority, license, refresh cadence.
Authority
U.S. Centers for Medicare and Medicaid Services
Tier
Tier-2 · profile-enrichment (renders on matched profiles)
Refresh cadence
Annual (July, post-performance-year scoring)
License
U.S. government public-domain works (17 U.S.C. § 105). Attribution required: 'Source: CMS QPP MIPS · Performance Year {YYYY}'. License ↗
Official URL
Attribution requirement
Source: CMS QPP MIPS · Performance Year {YYYY} · Last checked {YYYY-MM-DD}
What the source allows.
U.S. government public-domain works (17 U.S.C. § 105). CMS publishes QPP participation and performance data at qpp.cms.gov and data.cms.gov with explicit redistribution rights. Attribution must include the performance year.
What a single field looks like in the graph.
A worked example. Every field surfaced from this source carries this shape of provenance line — source · last checked · display rule · confidence (when applicable).
Field
MIPS final composite score (profile)
Sample value
Final score: 82.5/100 · Exceptional · PY2023 · NPI 1063717142
Provenance line
Source: CMS QPP MIPS · Performance Year 2023 · Methodology cms-qpp-mips/v1 · Display rule: per-clinician final_score + payment_adjustment_pct render on provider profile with performance year inline
Official API, bulk download, and Fonteum endpoints.
Official API / download
Bulk download
Fonteum surface
Common questions about CMS QPP MIPS.
- What is the CMS QPP MIPS score and how is it calculated?
- The Merit-based Incentive Payment System (MIPS) is CMS's value-based payment program for eligible clinicians under the Quality Payment Program (QPP). A composite MIPS score (0–100) is calculated from four performance categories: Quality (45%), Improvement Activities (15%), Promoting Interoperability (25%), and Cost (15%). Clinicians below the performance threshold receive a negative payment adjustment; those above receive a positive adjustment or exceptional performance bonus.
- Where can I download the QPP MIPS individual clinician data?
- CMS publishes annual QPP MIPS individual and group performance data at qpp.cms.gov. The public dataset is available for download as a CSV file. Performance Year 2023 data was published in 2024 and contains scores for approximately 477,000 clinicians across all eligible specialties.
- What is the national average MIPS composite score?
- For Performance Year 2023, the national mean composite MIPS score across all participating clinicians is 83.06 and the median is 85.49, per the Fonteum MIPS Score Distribution by Specialty 2023 study. Approximately 85.5% of participating clinicians scored in the high-performer range (≥ 75). See the full methodology at fonteum.com/research/mips-score-distribution-by-specialty-2023.
- What is the MIPS exceptional performance threshold?
- CMS sets the Exceptional Performance threshold annually. For Performance Year 2022, the threshold was 89.01 composite points. Clinicians above this threshold are eligible for the additional positive payment adjustment funded by negative adjustments from below-threshold clinicians. The exact threshold for each performance year is published in the CMS QPP final rule.
- Does a high MIPS score mean a clinician is a better doctor?
- A MIPS composite score reflects participation in CMS reporting programs and performance on CMS-defined measures — it is an administrative payment-adjustment metric, not an independent clinical quality rating. Fonteum surfaces the CMS-published score with full provenance (source · performance year · methodology version) and explicitly notes that the score is not an editorial endorsement of clinical quality.
Where this source already shows up.
Verticals where this source renders today
- dermatologists
- plastic-surgeons
- chiropractors
Related sources in the graph
- /sources → The full source library — every dataset Fonteum cites.
- /data-provenance → The provider graph — pipeline diagram, source-family clusters, field-level provenance examples, display rules.
- /methodology → Network-wide sourcing, refresh cadence, and corrections policy.
- /editorial-policy → Independence, sourcing, conflicts, corrections, retractions.