{"data":{"id":"us/42-cfr-414.1430","jurisdiction":"us","citation":"42 CFR 414.1430","heading":"Qualifying APM participant determination: QP and partial QP thresholds.","body":"(a) Medicare Option—(1) QP payment amount threshold. The QP payment amount thresholds are the following values for the indicated payment years:\n(i) 2019 and 2020: 25 percent.\n(ii) 2021 and 2022: 50 percent.\n(iii) 2023 and 2024: 50 percent.\n(iv) 2025: 50 percent.\n(v) 2026: 50 percent.\n(vi) 2027 and later: 75 percent.\n(2) Partial QP payment amount threshold. The Partial QP payment amount thresholds are the following values for the indicated payment years:\n(i) 2019 and 2020: 20 percent.\n(ii) 2021 and 2022: 40 percent.\n(iii) 2023 and 2024: 40 percent.\n(iv) 2025: 40 percent.\n(v) 2026: 40 percent.\n(vi) 2027 and later: 50 percent.\n(3) QP patient count threshold. The QP patient count thresholds are the following values for the indicated payment years:\n(i) 2019 and 2020: 20 percent\n(ii) 2021 and 2022: 35 percent\n(iii) 2023 and 2024: 35 percent.\n(iv) 2025: 35 percent.\n(v) 2026: 35 percent.\n(vi) 2027 and later: 50 percent.\n(4) Partial QP patient count threshold. The Partial QP patient count thresholds are the following values for the indicated payment years:\n(i) 2019 and 2020: 10 percent\n(ii) 2021 and 2022: 25 percent\n(iii) 2023 and 2024: 25 percent.\n(iv) 2025: 25 percent.\n(v) 2026: 25 percent.\n(vi) 2027 and later: 35 percent.\n(b) All-Payer Combination Option—(1) QP payment amount threshold.\n(i) The QP payment amount thresholds are the following values for the indicated payment years:\n(A) 2021 through 2026: 50 percent.\n(B) 2027 and later: 75 percent.\n(ii) To meet the QP payment amount threshold under this option, the eligible clinician must also meet a 25 percent QP payment amount threshold under the Medicare Option.\n(2) Partial QP payment amount threshold. (i) The Partial QP payment amount thresholds are the following values for the indicated payment years:\n(A) 2021 through 2026: 40 percent.\n(B) 2027 and later: 50 percent.\n(ii) To meet the QP payment amount threshold under this option, the eligible clinician must also meet a 20 percent Partial QP payment amount threshold under the Medicare Option.\n(3) QP patient count threshold. (i) The QP patient count thresholds are the following values for the indicated payment years:\n(A) 2021 through 2026: 35 percent.\n(B) 2027 and later: 50 percent.\n(ii) To meet the QP patient count threshold under this option, the eligible clinician must also meet a 20 percent QP patient count threshold under the Medicare Option.\n(4) Partial QP patient count threshold. (i) The Partial QP patient count thresholds are the following values for the indicated payment years:\n(A) 2021 through 2026: 25 percent.\n(B) 2027 and later: 35 percent.\n(ii) To meet the Partial QP patient count threshold under this option, the eligible clinician group or eligible clinician must also meet a 10 percent QP patient count threshold under the Medicare Option.","path":["Title 42—Public Health","CHAPTER IV—CENTERS FOR MEDICARE \u0026 MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES","SUBCHAPTER B—MEDICARE PROGRAM","PART 414—PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES","Subpart O—Merit-Based Incentive Payment System and Alternative Payment Model Incentive"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-42.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:11Z","sha256":"2efe2927c9713a1c5c1ebd3004c88edc5c74d8b576c52317c2826128ea849598","source_id":"us-cfr","stale":true,"prev":"us/42-cfr-414.1425","next":"us/42-cfr-414.1435"},"notice":"GroundRules: Original legal text. Not legal advice."}