Calendar Year (CY) 2027 CMS Physician Fee Schedule (PFS) Proposed Rule
The Centers for Medicare & Medicaid Services (CMS) has released the CY 2027 Medicare PFS Proposed Rule, which includes proposed policies for QPP. The proposed rule includes proposals for MIPS and Advanced Alternative Payment Models (APMs), and includes several Requests for Information (RFIs).
Key QPP proposals that are applicable to small practices include:
Learn more about the QPP proposals by reviewing the following resources:
2026 MIPS Value Pathway (MVP) Registration is Open until November 30
The MVP registration window is open for the 2026 performance year. Individuals, groups, subgroups, and APM Entities that wish to report an MVP can register or update an existing registration until November 30, 2026, at 8 p.m. ET.
Did you know?
Clinicians and groups registered for an MVP may report traditional MIPS instead of, or in addition to, the MVP you registered for.
To register, you’ll sign in to the QPP website with your HCQIS Access and Roles Profile (HARP) account.
You must have a HARP account and a QPP Security Official role to complete the MVP Registration.
For more information on obtaining the QPP Security Official role, review the Connect to an Organization document in the QPP Access User Guide (ZIP, 5MB).
Prepare for MVP Registration
Before you register, you’ll need to have the following items ready:
Additional Information for Group Registration
Starting in 2026, to register for MVP reporting as a group, your practice will need to attest to their specialty composition (whether you’re a single specialty group or multispecialty small practice) during the MVP registration process. We won't make this determination for you. All other groups will need to participate as subgroups or as individuals (if eligible) to report an MVP.
A single specialty group means a group that consists of clinicians in one specialty type, or clinicians in more than one specialty type with a single clinical focus of care. For example, a group consisting of internists, cardiologists, nurse practitioners, and physician assistants that are focused on providing cardiovascular care could attest to being a single specialty group and register to report an MVP as a group.
Learn more in the MVPs Group and Subgroup Participation Examples (PDF).
How to Register
Individuals, groups, subgroups and APM Entities will register through the QPP website. You'll need to have the Security Official role to register your organization. Please refer to the QPP Access User Guide (ZIP, 5MB) for information about obtaining a Security Official role for your organization. To register:
Note: If the CAHPS for MIPS Survey is an available measure in your chosen MVP and you wish to administer it as one of your four required measures, you should have completed your MVP registration and a separate CAHPS for MIPS Survey registration by June 30, 2026, at 8 p.m. ET. Visit the QPP website to learn more about CAHPS for MIPS registration.
Additional Resources
Reminder: 2026 Quality Payment Program Exception Applications are Available
The 2026 Quality Payment Program (QPP) exception applications are available now through December 31, 2026, at 8 p.m. ET. There are 2 types of exception applications allowing participants to indicate why they can’t report data for one or more Merit-based Incentive Payment System (MIPS) performance categories, MIPS Promoting Interoperability Performance Category Hardship Exception Application and MIPS Extreme and Uncontrollable Circumstances Exception Application.
MIPS Promoting Interoperability Performance Category Hardship Exception Application
Individual clinicians, groups, and virtual groups (or their third-party representative) can submit a MIPS Promoting Interoperability Performance Category Hardship Exception application for the following reasons:
This application is specific to the MIPS Promoting Interoperability performance category. If your application is approved, you won’t be required to report data for this performance category.
REMINDER: Small practices, hospital-based clinicians, non-patient-facing clinicians, and ambulatory surgical center (ASC) based clinicians are automatically excepted from having to report data for the MIPS Promoting Interoperability performance category.
MIPS Extreme and Uncontrollable Circumstances Exception Application
Individual clinicians, groups, and virtual groups
Individual clinicians, groups, and virtual groups (or their third-party representative) can submit a MIPS Extreme and Uncontrollable Circumstances (EUC) Exception application for one or more MIPS performance categories (quality, cost, improvement activities, and Promoting Interoperability) due to extreme and uncontrollable circumstances, defined as rare events entirely outside of your control and the control of the facility in which you practice, such as hurricanes, wildfires, floods, and other major disasters or public health emergencies.
These circumstances would:
If your application is approved, you won’t be required to report data for the performance category or categories approved in your application. However, please note that a qualifying data submission will override approved reweighting on a category-by-category basis. Qualifying data submissions will be scored, and those performance categories will contribute to your final score.
Alternative Payment Model Entities
Alternative Payment Model (APM) Entities, including Medicare Shared Savings Program Accountable Care Organizations (ACOs), can also submit a MIPS Extreme and Uncontrollable Circumstances application. APM Entities must request reweighting for all MIPS performance categories. If your application is approved, you won’t be required to report MIPS data, and any data submitted won’t be scored for purposes of MIPS.
How to Apply
To submit either exception application:
Additional Resources