MIPS performance categories explained

For the 2026 performance year, Traditional MIPS and MVP reporting generally use the following performance category weights:

• Quality: 30%
• Cost: 30%
• Improvement Activities: 15%
• Promoting Interoperability: 25%

These weights may change when a category is reweighted due to special status, hardship exceptions, lack of applicable cost measures, or other QPP rules. Practices should confirm current weighting through official QPP resources before finalizing reporting plans.

The MIPS final score is calculated on a 0 to 100 point scale. For the 2026 performance year, the performance threshold is 75 points.

The Quality category measures performance on selected clinical quality measures. For 2026, Quality generally counts for 30% of the MIPS final score under Traditional MIPS and MVP reporting.

For Traditional MIPS, practices generally report 6 quality measures, including 1 outcome measure or high-priority measure, or a complete specialty measure set when applicable. Quality data is collected for the full 12-month performance period from January 1, 2026 through December 31, 2026.

Each reported quality measure must meet the 75% data completeness requirement, meaning the practice must report performance data for at least 75% of denominator-eligible cases for the measure.

• Quality generally counts for 30% of the final MIPS score
• Traditional MIPS generally requires 6 quality measures
• At least 1 outcome measure or high-priority measure is generally required when applicable
• The Quality performance period is January 1 through December 31, 2026
• Reported measures must generally meet 75% data completeness
• Measure selection should match specialty, patient population, and documentation workflows

The Improvement Activities category recognizes clinical practice improvement efforts. For 2026, Improvement Activities generally count for 15% of the MIPS final score. Beginning with the 2025 performance period, individual improvement activities are no longer assigned high or medium weights.

For 2026 Traditional MIPS, practices generally attest to 2 improvement activities. Small practices and certain clinicians generally only need to attest to 1 improvement activity. Practices attesting to Patient-Centered Medical Home status may also satisfy the Improvement Activities requirement depending on the applicable QPP rules.

For MVP reporting, participants generally attest to 1 improvement activity from the selected MVP or attest to Patient-Centered Medical Home status when applicable.

Improvement Activities generally require a continuous 90-day performance period during the 2026 performance year unless the specific activity description states otherwise. Practices should choose activities that genuinely match their workflows and should maintain supporting documentation for the activities they attest to.

• Improvement Activities generally count for 15% of the final MIPS score
• Individual improvement activities are no longer assigned high or medium weights
• Traditional MIPS generally requires 2 improvement activities
• Small practices and certain clinicians generally need 1 improvement activity
• MVP reporting generally requires 1 improvement activity from the selected MVP
• Activities generally require a continuous 90-day performance period
• The last continuous 90-day period in 2026 begins October 3, 2026
• Documentation should support that the activity was actually performed

Promoting Interoperability measures the use of certified electronic health record technology to support electronic prescribing, health information exchange, provider-to-patient exchange, public health and clinical data exchange, and protection of patient health information.

For 2026, Promoting Interoperability generally counts for 25% of the MIPS final score. Practices must use CEHRT and collect data for a minimum of 180 continuous days during calendar year 2026, unless the category is reweighted or an applicable exception applies.

• Promoting Interoperability generally counts for 25% of the final MIPS score
• CEHRT must be in place by the first day of the PI performance period
• Data must generally be collected for at least 180 continuous days
• July 5, 2026 is the last day to start a 180-day PI performance period
• Required measures and attestations should be reviewed before the PI period begins
• Some clinicians, groups, or practice types may qualify for automatic reweighting or hardship exceptions
• Supporting documentation should be retained according to QPP documentation expectations

Promoting Interoperability is often one of the most operationally sensitive categories because it depends on EHR configuration, CEHRT status, measure setup, workflows, exclusions, attestations, and documentation.

The Cost category evaluates Medicare claims-based cost measures when applicable. For 2026, Cost generally counts for 30% of the MIPS final score.

Unlike Quality, Improvement Activities, and Promoting Interoperability, practices generally do not submit separate Cost data. CMS calculates Cost performance using Medicare administrative claims data when applicable cost measures can be attributed to the clinician or group.

• Cost generally counts for 30% of the final MIPS score
• Cost is generally calculated from Medicare administrative claims
• Practices usually do not submit separate Cost category data
• Cost measures may include broad episode-based measures or specialty-specific episode measures when applicable
• Cost may be reweighted if no applicable cost measures can be calculated
• Practices should still understand cost exposure because it can materially affect the final score

Not every practice is scored under the standard 30%, 30%, 15%, and 25% weighting. QPP rules may reweight a performance category when a clinician or group has a special status, an approved hardship exception, no applicable cost measures, or another qualifying circumstance.

• Promoting Interoperability may be reweighted for certain special statuses or approved hardship exceptions
• Small practices may have Promoting Interoperability automatically reweighted in some circumstances
• Hospital-based, ambulatory surgical center-based, and non-patient-facing clinicians may have different PI requirements
• Cost may be reweighted when no applicable cost measures can be calculated
• When a category is reweighted, its weight is redistributed according to QPP scoring rules
• Practices should verify reweighting status before assuming final category weights

The MIPS final score is calculated on a 0 to 100 point scale. For 2026, the performance threshold is 75 points. Performance in each scored category contributes to the final score based on the category weight assigned for that clinician, group, subgroup, virtual group, or APM Entity.

Because category weights can change due to reweighting, practices should not assume the standard weights apply in every case. A small practice, hospital-based group, non-patient-facing clinician, or practice without applicable cost measures may have a different scoring distribution.

• Final score is calculated on a 0 to 100 point scale
• 2026 performance threshold is 75 points
• Standard category weights may not apply when reweighting occurs
• Category performance should be reviewed throughout the year
• Measure selection, documentation, EHR readiness, and claims patterns can all affect performance
• Final score and payment adjustment outcomes are governed by QPP rules