MIPS Tidbits


APTA MIPS Website: http://www.apta.org/MIPS/ParticipationOverview/

Have you determined yet if you or any of your staff are required to participate in the Merit-Based Incentive Payment system?

You are required to participate if you meet all three of the Low Volume Threshold requirements

  • More than $90,000 in Medicare allowed charges in the two determining years
  • More than 200 Medicare allowed services (read CPT codes)
  • More than 200 Medicare Part B patients seen in the year.

If you only meet one or two of the above requirements you may choose to participate but are not required. If you are required you should set up a process within your practice to reliably collect this data.


There are 4 Quality Measures in the PT/OT set available for PT’s that must be reported through claims (if you are a small practice) or through a qualified registry. You may report up to 6 if appropriate to the patient and your practice

  • 128 Preventative Care and Screening: Body Mass Index Screening and Follow-up Plan
  • 130 Documentation of Current Medication in the Medical Record
  • 131 Pain Assessment and Follow-up
  • 182 Functional Outcome Assessment 

You must collect this data on at least 60% of all Medicare Part B patients if you are reporting on claims.


If you are reporting Quality Measures through a registry you must report on 6 measures for at least 60% of all patients regardless of payer. You may choose to report from any of the eligible PT/OT measures as well as any of the following additional measures (FOTO measures):

  • Functional Status Change for Patients with Knee Impairments.
  • Functional Status Change for Patients with Hip Impairments.
  • Functional Status Change for Patients with Foot or Ankle Impairments.
  • Functional Status Change for Patients with Lumbar Impairments.
  • Functional Status Change for Patients with Shoulder Impairments.
  • Functional Status Change for Patients with Elbow, Wrist or Hand Impairments
  • Functional Status Change for Patients with Other General Orthopedic Impairments. 

You are required to report participation in Improvement Activities for one 90 day period during the reporting year in some combination of the following:

  • 2 high weighted activities
  • 1 high weighted and 2 medium weighted activities
  • 4 medium weighted activities


Examples of Improvement Activities are:

  • Promote use of patient-reported outcome tools
  • Collection and follow-up on patient experience and satisfaction data on beneficiary engagement
  • Improved Practices that disseminate appropriate self-management materials.

These are reported once per year by attestation on the Medicare website.

APTA 2018 in Review
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