MIPS participation for physical therapists depends on three low-volume thresholds. You must participate if you exceed $90,000 in Medicare Part B allowed charges, serve more than 200 Medicare beneficiaries, and bill more than 200 covered professional services in a year.
The performance threshold stays at 75 points out of 100 for the 2026 performance year. Scores at or above this level avoid the negative payment adjustment. Scores below 75 can trigger a penalty up to negative 9 percent on Medicare Part B payments.
Promoting Interoperability becomes a required category for many physical therapists in their first year of participation. You report on measures such as e-prescribing, patient access to health information, and health information exchange.
Quality measures relevant to physical therapy include functional status change, pain management, and fall risk assessment. Choose measures that align with your patient population and documentation strengths. Data completeness must reach at least 75 percent of denominator-eligible cases.
You can check your participation status through the QPP Participation Status lookup tool on qpp.cms.gov using your NPI. The tool reflects the two determination periods CMS uses each year.
Groups have the option to report at the group level. This approach can simplify reporting when some therapists fall below the thresholds individually but the group as a whole exceeds them.
Exceptional performance bonuses remain available for scores well above the threshold, though budget neutrality rules apply. Focus first on meeting the 75-point mark.
MIPS strategy support is available through the consulting services listed at /consulting/.
Get a free revenue cycle assessment at therapyrevenuepros.com/contact/