Physician Payment: QPP and MACRA


Below are notices, milestones and resources to help you navigate payment changes in the Quality Payment Program (PPQ), the Medicare Access and CHIP Reauthorization Act (MACRA), and more. 

January 2023: Advancing Interoperability and Improving the Prior Authorization Process

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule that outlines policy changes to the prior authorization (PA) process for several of the agency’s benefit programs. The rule will help alleviate burdensome procedures of prior authorization by streamlining the process for both patients and providers. Read the proposed rule summary here.


November 1, 2022: CY 2023 Medicare Physician Fee Schedule Rule

CMS released the CY 2023 Medicare Physician Schedule (MPFS) rule. Read our summary here.


July 7, 2022: CY 2023 Medicare Physician Fee Schedule Proposed Rule

CMS released the CY 2023 Medicare Physician Fee Schedule (MPFS) proposed rule and fact sheet. Read our detailed summary or one-pager for more information.

December 15, 2021: Surprise Billing Requirements

Beginning January 1, 2022, new requirements will go into effect for healthcare providers to protect patients from surprise bills. Read our fact sheet for more details. 

October 6, 2021: 2022 Medicare Cuts Fact Sheet 

Physicians are facing the “perfect storm,” which will bring almost a 10 percent cut in Medicare reimbursement on January 1, 2022. Congress must act to avert this cut because the administration does not have the authority to do so. Learn more.

September 12, 2021: CEU Session Discussing Physician Payment.  

We delivered a briefing titled "Legislation & Regulations Affecting Endocrinologists: What You Need to Know About Medicare Physician Payment, Telehealth Expansion, and Drug Pricing." Watch a recording.

August 10, 2021: CY 2022 Physician Fee Schedule Proposed Rule Summary

Click here for a summary created by the Endocrine Society of the calendar year 2022 proposed Physician Fee Schedule.

April 1, 2021: Endocrine Society Physician Payment Updates

Senate Reaches Deal to Avert Medicare Cuts

As you may know, two percent reduction in Medicare payments to providers was scheduled to go into effect on April 1stLast week, the U.S. Senate overwhelmingly passed an agreement to avert these cutsThe legislation will delay these reimbursement cuts through the end of 2021. The House of Representatives is expected to vote on the legislation the week of April 12.In anticipation of this possible Congressional action, the Centers for Medicare and Medicaid Services (CMS) has instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on or after April 1, 2021, for a short period without affecting providers’ cash flow. This will minimize the volume of claims the MACs must reprocess when Congress extends the suspension of the Medicare cuts; the MACs also will automatically reprocess any claims paid with the reduction applied, if necessary.

Society Makes Important Change to E/M Requirement at CPT Panel

Earlier this month, the American Medical Association’s CPT Panel released technical corrections to the outpatient E/M documents requirements, which included a change to remove proposed limits on how insulin would have been considered when being monitored. The Endocrine Society advocated for this change and worked with AACE to revise this language at the February CPT meeting. The changes are retroactive to January 1st, 2021.

FAQs on Coding and Billing for 99091 and 99457

The Endocrine Society has worked to help our members determine how to appropriately bill for the work delivered to patients with insulin pumps. Recently, we sent information with clarification by CMS on coding and billing for remote physiologic monitoring (RPM) codes 99091 and 99457 and specifically how these codes could be used to reimburse for the care delivered to insulin pump patients. We have developed an FAQ document to help you navigate these changes and answer any questions you may have about coding and billing for these codesYou can view the FAQ document here.

Update: Billing Medicare for Treating Patients with Insulin Pumps

The Endocrine Society has been working to help members determine how to appropriately bill for the work delivered to patients with insulin pumps. Since January 1, 2019, Medicare has been paid for remote physiologic monitoring (RPM) services since January 1, 2019, but there has been confusion regarding how these services may apply to care associated with insulin pumps. Read our explanation here. 

UPDATE: CMS Releases Physician Payment Final Rule for CY 2021

On December 1, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule (MPFS) final rule for CY 2021.  This rule updates payment policies and payment rates for Part B services furnished under the MPFS, as well as makes changes to the Quality Payment Program (QPP).  See below for summary and analysis of the rule:

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula for Medicare reimbursement. For eligible clinicians, the Quality Payment Program (QPP) replaces previous Medicare Part B payment programs with the Merit-based Incentive Payment Program (MIPS) and Advanced Alternative Payment Models (Advanced APMs). Explore information and resources to learn how this affects your practice. Questions? Email us at [email protected].

SPOTLIGHT: Quality Payment Program Resource Library


What is MACRA?

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 is legislation that established a new payment system for doctors who treat Medicare patients, changing the way Medicare doctors are reimbursed. Under MACRA, the Sustainable Growth Rate (SGR) Formula was repealed, and providers are instead paid based on the quality and effectiveness of the care they provide.

What is the Quality Payment Program?

Quality Payment Program (QPP) is the name of the Medicare payment program set in place by MACRA. QPP allows Medicare providers to choose one of two payment tracks: Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (Advanced APMs).

How does this affect me or my practice?

You can find out whether you are part of the QPP by entering your provider number into the tool on this page: Providers are part of the QPP if:

  • You participate in an Advanced APM or
  • You bill Medicare more than $90,000 in Part B allowed charges per year OR provide care for more than 200 Medicare patients per year

There is additional technical support available for practices in Small, Rural and Health Professional Shortage Areas (HPSAs). If you meet the eligibility requirements above, you must begin participation in the QPP on January 1 of the reporting year. Performance data for Year 1 must be submitted by March 31, 2018 in order to avoid a payment penalty.


Understanding the Measurement Criteria and Reporting Requirements

The Merit-based Incentive Payment System (MIPS) uses performance-based measures to determine Medicare payment adjustments. Medicare will use the four categories below to determine whether eligible physicians participating in MIPS will receive a positive, negative, or neutral payment adjustment to their Medicare payments. Click on the icons below to select and download the measurement CSV files for Quality, Advancing Care Information, and Improvement Activities. Fora full list of measures for each category, please see the links below. 

QualityQuality (45%)
Replaces PQRS. Report at least six measures for the full calendar year.

Advancing Care InformationAdvancing Care Information (25%)—Replaces Medicare EHR Incentive Program (Meaningful Use). Fulfill the required measures for a minimum of 90 days.

Improvement ActivitiesImprovement Activities (15%)mdash;110+ activities focused on care coordination, beneficiary engagement, and patient safety. Attest that you completed up to 4 Improvement Activities for a minimum of 90 days.

CostCost (15%)mdash;Replaces Value-Based Modifier. No data submission required. Calculated from adjudicated claims.

Advanced APMs

Participating in Advanced APMs

You may be exempt from MIPS if you participate in an alternative payment model. Alternative Payment Models (APMs) are payment approaches that give incentives for high-quality and cost-efficient care. Advanced APMs are a type of APM that allow practices to take on some risk related to patient outcomes. To find Advanced APMs accepting enrollment, please visit

In 2019, clinicians who participate in one of the Advanced APMs listed below will be exempt from the MIPS reporting requirements and will receive a 5% payment bonus from 2019 – 2024. If you leave an Advanced APM during 2018, make sure you have met the Advanced APM threshold or submit MIPS data to avoid a penalty.

Qualifying Advanced APMs


Endocrine Society Resources

Centers for Medicare & Medicaid Services

Quality Payment Program—A regularly updated resource to help eligible providers understand QPP components. Includes:

Transforming Clinical Practice Initiative—The initiative is one part of a strategy advanced by the Affordable Care Act to strengthen the quality of patient care and spend health care dollars more wisely.

Support for Small Practices—List of QPP technical assistance by region for practices with 15 or fewer clinicians.

American Medical Association

MIPS Action Plan—A resource for physicians not yet participating in the new Medicare payment program is designed to help practices prepare for, and operate under, the regulation.

Preparing Your Practice for Value-based Care—This module will help the user transition to a value-based care model.

Inside Medicare's New Payment System (Podcast Series)—Podcasts presented by ReachMD that cover various topics related to QPP, such as MACRA for small practices and how to use an EHR to participate in MACRA

American College of Physicians

MACRA and the Quality Payment Program resource center


MACRA—Medicare Access and CHIP Reauthorization Act of 2015 is landmark legislation that changes how Medicare pays physicians.

QPP—Quality Payment Program is the new Medicare Part B payment program focused on care quality.

MIPS—Merit-based Incentive Payment System is the payment system for eligible clinicians who are not participating in an Advanced APM. The payments in MIPS are based on four categories: Quality, Improvement Activities, Advancing Care Information, and Cost.

APM—An Advanced Payment Model is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care.

Advanced APM—Advanced Alternative Payment Models are a subset of APMs that let practices earn more for taking on some risk related to their patients' outcomes.

CMS—Centers for Medicare & Medicaid Services is a US federal agency under the Department of Health and Human Services which administers Medicare, Medicaid, and the State Children's Health Insurance Program.

HHS—United States Department of Health and Human Services


Become a Member

Join our endocrine community and become a member! Only members receive access to a variety of member benefits that will enhance your career. If your membership has lapsed, rejoin today so that you can continue to receive your membership benefits.

Join our endocrine community and become a member! Only members receive access to a variety of member benefits that will enhance your career. If your membership has lapsed, rejoin today so that you can continue to receive your membership benefits.

Back to top

Who We Are

For 100 years, the Endocrine Society has been at the forefront of hormone science and public health. Read about our history and how we continue to serve the endocrine community.