2026 MIPS criteria maintain current standards and offer new option for MVP reporting

As the 2026 Centers for Medicare and Medicaid Services (CMS) reporting year begins, optometrists can expect consistency, as the Merit-based Incentive Payment System (MIPS) remains essentially unchanged, according to AOA Coding and Reimbursement Committee Chair Rebecca Wartman, O.D.

MIPS, which determines reimbursement rates for traditional Medicare patients, will continue to exempt low-volume offices. Practices that bill less than $90,000 to traditional Medicare, see fewer than 200 Medicare patients, or provide fewer than 200 Medicare services will remain exempt from MIPS reporting requirements. Similarly, practices with fewer than 15 providers can continue to report their Quality Measures via claims and are exempt from Promoting Interoperability reporting.

Practices will need to maintain a MIPS score of at least 75 points to avoid a 9% penalty on Medicare reimbursements in 2028. Exceeding that threshold can also lead to a bonus reimbursement rate up to 9%.

New option for reporting metric

The Coding and Reimbursement Committee encourages practices to use the newly available Ophthalmic Care MIPS Value Pathway (MVP), which reduces the number of required quality measures from six to four compared with the traditional MVP, Dr. Wartman says. Additionally, the Ophthalmic MVP only requires one improvement activity, regardless of practice size.

This streamlined reporting option is a welcome alternative to the more labor-intensive traditional MIPS for busy practices. Opting for the Ophthalmic MVP track requires applying for an MVP ID number. Registration is open from April 1 to Nov. 30, 2026, and can be cancelled at any time during that period, Dr. Wartman says.

The 2026 performance category weights vary based on practice size. Small practices will see Quality and Improvement Activities each weighted at 50%, while Cost and Promoting Interoperability remain at 0%. Larger practices with 16 or more providers face a different distribution: Quality at 50%, Improvement Activities at 30%, Promoting Interoperability at 20%, and Cost at 0%.

AOA resources for successful MIPS compliance

Before your practice begins reporting, verify your Quality Payment Program (QPP) participation status. Enter your national provider identifier at https://qpp.cms.gov/eligibility-participation/eligibility/check to view your QPP status by year. If your practice has special circumstances that might lead to an exemption, you may apply for an exemption here.

The 2026 performance year is already underway, but there are several key dates to note, including the registration window for MVPs and exceptions. The QPP Timeline is available here. 

The AOA has two resources to help providers navigate MIPS reporting in 2026. The Claims Based Reporting guide, which outlines all Medicare Part B claims measures, provides a comprehensive list of potential claims by CPT code. For a more in-depth look at the changes and reporting options, #AskAOA: MIPS 2026, a webinar hosted by Dr. Wartman and Harvey Richman, O.D., dives into everything you need to know to stay compliant and maximize your reimbursements.