^{NOTE: This toolkit is for information purposes and summarizes AUA’s understanding of information from the U.S. Centers for Medicare & Medicaid Services (CMS). For official CMS wording, more detailed discussion, and/or up-to-date information on these or related topics, visit the CMS website.}

This toolkit provides an overview of the 2026 participation rules, performance categories, and scoring approaches for the Traditional Merit-based Incentive Payment System (MIPS) reporting option. 

The Medicare Access and CHIP Reauthorization Act of 2015— also known as MACRA—was signed into law on April 16, 2015. This law, which created the Quality Payment Program (QPP), changed the way physicians are paid for providing services under Medicare. It continued the move away from fee-for-service payment, toward value-based payment approaches that endeavor to pay clinicians based on the quality, value, and outcomes of the care they provide.

Eligible clinicians can participate in the QPP through Merit-based Incentive Payment System (MIPS) or  Advanced Alternative Payment Models (APMs). They can complete MIPS reporting through one of three options.

Figure 1. QPP Reporting Options

^{(Source: U.S. Centers for Medicare & Medicaid Services)}

Clinicians should visit the CMS QPP Participation Status Lookup Tool to determine their MIPS eligibility status. MIPS participation is available through the following options:

• As an individual
• As a part of a group, virtual group, or subgroup
• As an APM Entity

Check out the following resources for more information:

• Quality Payment Program (QPP) Information
• MIPS Eligibility Information
• Exceptions to MIPS Participation
• Special Statuses (for MIPS Participation)

Figure 2. MIPS Performance Categories for Individuals, Groups, and Virtual Groups

^{NOTE: Performance category weights vary based on the participation option.  Weights also vary for small practices that do not submit PI data or when re-weighting is applied (e.g., due to hardship exemptions or extreme and uncontrollable circumstances).}

MIPS-eligible clinicians earn payment adjustments (either bonuses or penalties) for Medicare Part B covered professional services, based on four performance categories:

• The Quality category assesses the quality of care delivered by measuring health care processes, outcomes, and patient experiences of care.
• The Cost category assesses the cost of the care provided based on Medicare Part B claims.
• The Improvement Activities (IA) category assesses participation in activities that improve clinical practice and support practice engagement.
• The Promoting Interoperability (PI) category assesses the promotion of patient engagement and electronic exchange of health information using certified electronic health record technology (CEHRT).

CMS scores each performance category separately.  The final MIPS score, which ranges from 0 to 100 points, is calculated by adding together the final scores for each of the four performance categories.

Table 1. Performance Category Weights by MIPS Reporting Option

Each performance category has an assigned weight used in calculating a final MIPS score. The performance category weights are the same for the Traditional MIPS and MVP reporting options.  Participants reporting through either option will be scored on all four performance categories.  In contrast, the final MIPS score excludes the Cost category for APM Entities and excludes the Promoting Interoperability category for small practices.

Table 2. 2026 MIPS Payment Adjustments

^{(Source: MIPS Payment Adjustments)}

MIPS is a budget-neutral program, meaning the positive payment adjustments (bonuses) are funded through the negative payment adjustments (penalties). The performance threshold for 2026 remains 75 points (out of 100).  Participants need a score higher than 75.00 points to receive a positive payment adjustment (bonus).

Check out the following resource(s) for more information:

• How CMS Calculates the MIPS Final Score

^{NOTE: Performance category weights vary based on the participation option.  Weights also vary for small practices that do not submit PI data or when re-weighting is applied (e.g., due to hardship exemptions or extreme and uncontrollable circumstances).}

The Quality performance category focuses on measures that assess health care processes, outcomes, and patient experiences of care. The AUA recommends that participants consider the following when selecting and reporting measures:

• Clinical conditions treated
• Practice improvement goals
• Current quality improvement efforts
• Quality information already being reported to other payers or entities
• Effects of measure reporting on overall MIPS score
• Need for reporting to achieve measure benchmarks

Check out the following resource(s) for more information:

• 2026 Quality Quick Start Guide
• MIPS Quality Performance Category Fact Sheet

Quality Reporting Requirements

CMS gauges how well participants score on each reported measure and assigns a point total. To complete the quality requirements for Traditional MIPS reporting, participants must:

• Report 6 quality measures or a complete specialty set.
  • One of the six measures must be an outcome or high-priority measure.
  • IMPORTANT: Participants should consider reporting as many relevant measures as possible to ensure that CMS continues to include urology-relevant measures in the MIPS program.
• Collect and submit data from January 1, 2026, to December 31, 2026 (i.e., a 12-month period).
• Meet the data completeness requirement, which requires reporting performance data for at least 75% of the denominator-eligible cases, for each measure.

Check out the following resource(s) for more information:

• 2026 MIPS Quality Measures List

Quality Data Collection

Participants may use a combination of the following measure options to complete MIPS reporting for the 2026 performance year. Click on the links below for more information.

• Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey Measure
• Electronic Clinical Quality (eCQMs) Measures
• Medicare Part B Claims Measures
• MIPS Clinical Quality (MIPS CQMs) Measures
• Qualified Clinical Data Registry (QCDR) Measures

Automatically Calculated Quality Measures

Table 3. Automatically Calculated Quality Measures

CMS will also collect and use administrative claims data to calculate 4 quality measures.  They will score participants on each of the 4 measures for which they meet the requirements. The two measures most relevant to urology are:

• Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions (MCC)
• Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for the Merit-based Incentive Payment System (MIPS) Eligible Groups

Scoring the Quality Category

MIPS participants earn points for the Quality category based on how their results compare to those of other participants.

• Measure results are compared to benchmarks based on historical data to determine the number of achievable points for submitted measures.
• Next, bonus points are awarded as applicable, and a percentage score is computed.
• Then, the final score for the Quality performance category is calculated by weighting the Quality percentage score by the Quality weight (for 2026, this is 30 percent for individuals, groups, and virtual groups).
• Six bonus points will be awarded to small practices that submit data for at least one quality measure.

Measure Benchmarks

Benchmarks are the point of comparison used to score submitted measures. CMS scores each measure by comparing participants’ performance to the benchmark, for a maximum of 10 points. A quality measure will be scored against a benchmark if all the following conditions are met:

• The measure meets the data completion criteria. For the 2026 performance year, it is a 75% threshold.
• The measure meets the case minimum criteria, which most often is 20 cases, and
• A benchmark exists for the measure’s collection type.

A series of historical benchmarks is established, when possible, for each measure, for each reporting mechanism (e.g., if a measure can be reported as a CQM and an eCQM, it will have two benchmarks). For 2026, those benchmarks were calculated using data reported for 2024. 

• Typically, measures can earn between 1 and 10 achievement points if they can be scored against a benchmark.
• Participants can use the benchmark file to determine which decile their performance falls into, then use this information to determine the score for that measure.

If a measure does not have a historical benchmark, CMS will attempt to calculate one using 2026 data. If no historical benchmark exists and one cannot be calculated using 2026 data, CMS will not award any points for that measure, unless the measure in its first or second year in the program.

Small practices will continue to earn 3 points for reporting on measures without a benchmark. MIPS participants may be able to earn as many as 10 additional percentage points if their score for the Quality category improved compared to their score in the previous year.

Check out the following resource(s) for more information:

• CMS Benchmark Files

Topped Out Measures

A measure is considered “topped out” by CMS when most participants who have reported the measure have scored very well on it. CMS has begun phasing out many of the topped-out measures and is trying to discourage participants from using remaining topped out measures by awarding lower point values.

• For some topped out measures, CMS does not award the full 10 points, even if measure results are perfect.
• When measures have been topped out for 2 consecutive years, for a specific collection type, the maximum number of points available is capped at 7 points.

In 2025, CMS established a topped-out measure benchmarking methodology for a subset of topped out quality measures belonging to specialty sets with limited measure choice.

• It removes the 7-point cap for specific topped out measures by collection type.
• It also allows specialties impacted by limited measure choice to be scored according to defined topped out measure benchmarks.

Check out the following resource(s) for more information:

• Topped-Out Measure Benchmarks Policy (Appendix E)

^{^Visit Appendix E in the 2026 Quality Quick Start Guide to see the list of quality measures that are subject to the topped-out measure benchmarks for the 2026 performance period.}

^{#Visit the 2026 Quality Quick Start Guide to access the table showing how the median performance rate for an administrative claims measure will be set at a score derived from the performance threshold.} 

^{NOTE: Performance category weights vary based on the participation option.  Weights also vary for small practices that do not submit PI data or when re-weighting is applied (e.g., due to hardship exemptions or extreme and uncontrollable circumstances).}

The measures included in the MIPS cost performance category assess the following for Medicare patients:

• Overall cost of care provided, with a focus on the primary care they received.
• Cost of services provided related to a hospital stay.
• Costs for items and services provided during specific episodes of care.

MIPS participants do not have to submit performance data to CMS for the Cost category. Instead, CMS uses Part A and B Medicare claims data (and, sometimes, Part D claims) to score clinicians on every MIPS cost measure for which attribution requirements are met.  Not all clinicians will qualify for all cost measures, and some may not qualify for any. 

Check out the following resource(s) for more information:

• Cost Section of the QPP Website (Traditional MIPS Requirements)

Population-based and Episode-based Cost Measures

There are 35 cost measures available for the 2026 performance year. Two (2) are population-based and thirty-three (33) are episode-based.

• Population-based cost measures focus on primary and inpatient care. The two (2) population-based cost measures for the 2026 performance year are:
  • Total Per Capita Cost (TPCC)
  • Medicare Spending per Beneficiary (MSPB) Clinician Measure
• Episode-based cost measures focus on procedures, acute inpatient medical conditions and chronic conditions.
  • They include only items and services that are related to the episode of care for a specific clinical condition or procedure, as opposed to all Medicare part A and B services over a specific timeframe. The length of the episode varies, depending on the measure.
  • The two episode-based cost measures most applicable to urology are:
    • Renal or Ureteral Stone Surgical Treatment
    • Prostate Cancer

Check out the following resources for more information:

• 2026 MIPS Cost Measure Information Forms

Scoring Cost Measures

CMS uses a comparison of performance on a measure to a performance period benchmark to determine measure achievement points. Cost measure benchmarks are calculated using performance period data (rather than historical data). To receive a score for the cost performance category, participants must meet the established case minimum and be scored on at least one measure.

There is a maximum cost improvement score of 1 percentage point available for the Cost performance category.

Check out the following resource(s) for more information:

• 2026 Scoring Guide

^{(Source: 2026 Quality Payment Program Final Rule Fact Sheet and Policy Comparison Table)}

^{NOTE: Performance category weights vary based on the participation option.  Weights also vary for small practices that do not submit PI data or when re-weighting is applied (e.g., due to hardship exemptions or extreme and uncontrollable circumstances).}

The Improvement Activities performance category measures participation in activities that improve clinical practice, care delivery, and outcomes.

• IAs must be implemented for at least one continuous 90-day performance period (during 2026) unless otherwise stated in the activity description.
• All IAs must begin no later than October 3, 2026 (to have a full 90-day performance window).

Check out the following resource(s) for more information:

• 2026 MIPS Improvement Activities Quick Start Guide

Selecting IAs

For the 2026 performance year, approximately 100 IAs are available across the following categories.

Prior to selecting IAs, practices should analyze their practices to identify:

• What areas within the practice need improvement?
• What changes would help to improve the patient’s experience?
• What existing improvement activities could satisfy the IA performance category?

Check out the following resource(s) for more information:

• 2026 Improvement Activities Inventory

Attesting IAs

Most clinicians must implement and submit 1 or 2 improvement activities to receive a maximum of 40 points for this category.

• One activity must be attested to (submitting a “yes”) by clinicians, groups, and virtual groups with the small practice, rural, non-patient facing, or health professional shortage area special status.
• Two activities must be attested to (submitting a “yes”) by all other MIPS eligible clinicians, groups, and virtual groups.

Participants must attest to their IAs, which can be done directly or through a third party such as the AQUA Registry.

• Documentation supporting improvement activities is not required at the time of attestation. However, documentation should be compiled and would be required in the event of a CMS audit.
• Participants must keep this documentation for six years after attestation.

The AUA recommends that participants document as much information as possible about the completed activities. For example:

• If administering a patient satisfaction survey for 90 days, note in the patient charts who received one and when.
• If attending an Institute for Healthcare Improvement event, save proof of registration and any materials (slides, handouts, etc.) that may have been distributed for the event.

Check out the following resource(s) for more information:

• 2026 MIPS Data Validation Criteria

^{(Source: 2026 MIPS Improvement Activities Quick Start Guide)}

^{NOTE: Performance category weights vary based on the participation option.  Weights also vary for small practices that do not submit PI data or when re-weighting is applied (e.g., due to hardship exemptions or extreme and uncontrollable circumstances).}

The PI performance category aims to foster the electronic exchange of health information using certified electronic health record technology (CEHRT) through 5 objectives:

• e-Prescribing
• Health Information Exchange
• Provider-to-Patient Exchange
• Public Health and Clinical Data Exchange
• Protect Patient Health Information

The use of technology to exchange and make use of information (i.e., interoperability) can help MIPS participants:

• Reduce the burden associated with communicating patient information and, by extension,
• Improve patient access to their health information,
• Improve information exchange between clinicians and pharmacies, and
• Improve the systematic collection, analysis, and interpretation of healthcare data.

Participants must do the following for the PI performance category:

• Use an EHR that meets the National Coordinator for Health Information Technology (ONC) certification criteria specified in 45 CFR 170.315of the Code of Federal Regulations.
• Collect data for the required measures through their certified EHR technology (CEHRT) for a minimum of 180 continuous days during the calendar year.

Check out the following resource(s) for more information:

• Promoting Interoperability: Traditional MIPS Requirements

Promoting Interoperability Exemptions

• Automatic reweighting to 0% will apply only to MIPS eligible clinicians, groups, and virtual groups, and APM Entities with the following special statuses (which means they are exempt from reporting PI data):
  • Ambulatory Surgical Center (ACS)-based
  • Hospital-based
  • Non-patient facing
  • Small practice
• When all their MIPS-eligible clinicians are individually exempt from reporting PI data, groups, virtual groups and APM Entities qualify for automatic reweighting and are exempt from reporting PI data.
• Those who are not automatically exempted must apply for an exception by December 31, 2026. Even if a participant received an exception previously, they must apply again in 2026.

Promoting Interoperability Exceptions

• Individuals, groups, virtual groups, APM Entities can submit a MIPS PI Performance Category Hardship Exception application, to request exemption from reporting PI data using one of the following reasons:
  • Using decertified EHR technology
  • Having insufficient internet connectivity
  • Lacking control over CEHRT availability
  • Facing extreme and uncontrollable circumstances
• If a hardship exception is approved, the PI category will receive a weight of 0% when calculating the final score. That 25% will be redistributed to another category unless data is submitted for the PI category.
  • The hardship exception results in the re-weighting of the PI category to zero. If any data are submitted for the PI category, the reweighting will be canceled, and the data will be scored. If a clinician has a reporting exception but submits data, the data will be scored, and the exemption will be canceled.
• Clinicians may also request reweighting to 0% due to a MIPS Extreme and Uncontrollable Circumstance exception. These allow for exemptions due to rare events that are completely outside your control and may apply to multiple performance categories.

Check out the following resource(s) for more information:

• Promoting Interoperability: Traditional MIPS Requirements

Promoting Interoperability Measures and Scoring

Participants must complete the following requirements to avoid receiving a 0 for the MIPS Promoting Interoperability performance category.

Figure 3. Promoting Interoperability Requirements

^{(Source: 2026 MIPS Promoting Interoperability Quick Start Guide)}

Participants can earn a total of 100 points based on the results of the required measures. Data for these measures must be collected during the same continuous 180-day period (or more) during the calendar year. For the 2026 performance year, the last day to start collecting data for the PI category is July 5, 2026.

Table 4.  2026 MIPS Promoting Interoperability Objectives, Measures*, and Available Points

^{*Review the measure exclusions and other details within the 2026 MIPS Promoting Interoperability Measures Specifications.
**Five bonus points are available through the measures within the Public Health and Clinical Data Exchange objective.}

As with the IA performance category, documentation supporting PI reporting is not required at the time of attestation. However, documentation should be compiled and would be required in the event of a CMS audit. Participants must keep this documentation for six years after attestation.

Check out the following resource(s) for more information:

• 2026 MIPS Promoting Interoperability Quick Start Guide (Appendix)
• MIPS Promoting Interoperability Performance Category Fact Sheet
• 2026 MIPS Promoting Interoperability Measure Specifications

Promoting Interoperability Performance Category Highlights

^{(Source: 2026 Quality Payment Program Final Rule Fact Sheet and Policy Comparison Table)}

The AUA Quality Registry, or AQUA Registry, was developed by urologists and designed to measure, report, and improve healthcare quality and patient outcomes. As a CMS recognized Qualified Clinical Data Registry (QCDR), practices can use AQUA to report MIPS information to CMS.

Practices are eligible to participate in the Registry if they use a compatible electronic health record (EHR) system and are in the United States.

Send an email to AQUA@auanet.org for more AQUA Registry-related information.

Check out the following resource(s) for more information:

• Learn More About the Benefits of AQUA Registry Participation
• Explore the AQUA Registry Subscription Options
• Learn How the AQUA Registry Supports Solo & Private Practices
• Learn How the AQUA Registry Supports Large Groups and Institutions

Quality Measures Supported in AQUA

The AQUA Registry supports 51 quality measures for the 2026 performance year, including:

• 7 QCDR measures that are limited to use by AQUA Registry participants,
• 28 CQMs measures that are publicly available, and
• 16 eCQMs measures that are publicly available

In some cases, AQUA supports both CQM and eCQM versions for the same measure concept.

Check out the following resource(s) for more information:

• 2026 AQUA QCDR Measure Specifications
• 2026 AQUA Supported Quality Measures Quicklist
• 2026 MIPS CQM Measure Specifications and Supporting Documents
• 2026 Electronic Clinical Quality Measure (eCQM) Specifications

Improvement Activities Supported in AQUA

The AUA reviewed approximately 100 IAs available for the 2026 performance year.

2026 AQUA Registry Reviewed IA Inventory List

Activities highlighted in blue are those that the AUA believes urologists should be able to easily implement or adapt for their practices. Activities highlighted in green can be completed through participation in the AQUA Registry.

Disclaimer: The AQUA Registry staff encourages practices to download and review CMS’ improvement activity (IA) data validation requirements.

Check out the following resource(s) for more information:

• 2026 IA Validation Requirements

Contact the CMS Quality Payment Program (QPP) Help Desk for additional information about the Traditional MIPS reporting option (e.g., MIPS eligibility, performance categories, payment adjustments)

• URL: https://qpp.cms.gov/
• Phone: 866-288-8292
• E-mail: QPP@cms.hhs.gov

Contact the AUA Quality & Measurement Department for additional information about the MIPS toolkit, Quality Improvement resources, and measures supported by the AQUA Registry.

• URL: https://www.auanet.org/guidelines-and-quality/quality-and-measurement
• E-mail: Quality@auanet.org

Contact the AQUA Registry for additional information about the registration process, subscription options, and participation benefits. 

• URL: https://www.auanet.org/research-and-data/aua-quality-(aqua)-registry
• E-mail: AQUA@AUAnet.org