CMS has released the highly anticipated Merit-Based Incentive Payment System (MIPS) quality measure benchmarks for 2025 performance year. CMS uses these benchmarks to determine the number of points clinicians earn for each quality measure reported, which will then factor into their final MIPS score and impact their Medicare Part B payment adjustment in 2027. As a reminder, the maximum penalty for the 2025 performance year (2027 payment year) is -9%. You can access the latest benchmark data files here. We recommend using this CMS site to access the benchmark file, as updates and revisions may be made throughout the year.
AAPM&R has reviewed the measures in the Physical Medicine specialty measure set and has identified several measures that are topped out and will be subject to a 7-point cap in the 2025 performance year, meaning they can earn a maximum of 7 out of 10 points on a measure with perfect performance:
- Advance Care Plan (both MIPS clinical quality measure (CQM) and claims-based measures)
- Documentation of Current Medications in the Medical Record (both MIPS CQM and electronic clinical quality measure (eCQM))
- Falls: Plan of Care
- Functional Outcome Assessment
- Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention (claims-based measure)
- Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented (claims-based measure)
Since some measures might have additional scoring limitations, we encourage members to review the 2025 benchmarks and consider their potential impact on MIPS reporting and performance scores. Stay tuned for further updates as CMS continues to refine the data, and please contact Academy staff at healthpolicy@aapmr.org with any questions or concerns.