Quality Scoring Logic

Learn About MIPS

Reporting Requirement

Scoring Logic

Quality

PI

IA

Cost

Summary

For 2025, CMS has updated the Quality category scoring logic. Some of the key changes to MIPS quality category scoring logic are:

Max
points
60

30% of final score

Choose 6 quality measures to report on out of 195 quality measures approved by CMS. This must include at least 1 Outcome measure or 1 High Priority Measure (if an outcome measure is not available).

Outcome/High Priority measures are either of the following types – Appropriate Use measure, Patient experience, Patient safety, Efficiency measures, Care coordination or opioid-related quality measure.

CMS will automatically calculate and score 4 administrative claims measures for individuals, groups, virtual groups, and APM Entities when such measures are applicable and if the individuals, groups, virtual groups, or APM Entities meet the requirements to be scored on the measure. The following are the 4 administrative claims measures automatically calculated and scored.

Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for the Merit-based Incentive Payment System (MIPS) Eligible Groups. (This measure is only applicable to groups and virtual groups).
Risk-Standardized Complication Rate (RSCR) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) for Merit-based Incentive Payment System (MIPS).
Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions.
Risk-Standardized Acute Unplanned Cardiovascular-Related Admission Rates for Patients with Heart Failure under MIPS

Improvement percent score

For 2025 Performance Year (PY), providers/practices can earn up to 10 percentage points based on the rate of their improvement in the Quality performance category from the previous year.

Topped Out measures

For 2025 PY, a special scoring cap of 7 points is applied to the measures that are identified as Topped Out.

An alternative benchmarking methodology is finalized for a subset of topped out measures that belong to specialty sets with limited measure choice and a high proportion of topped out measures, in areas that lack measure development, which precludes meaningful participation in MIPS.

Quick tip: Maximum score cannot exceed 100%

* Maximum number of points = Number of required measures x 10

Quick tip: Maximum score cannot exceed 100%
*Maximum number of points = Number of required measures x 10