Special Status

Some MIPS eligible clinicians (ECs) and groups may have alternate component weightings or reduced MIPS component requirements based on Special Status designations. Definitions for MIPS Special Statuses are described below.

Non-patient Facing
ECs reporting at the individual level are considered non-patient facing if they have 100 or fewer Medicare Part B patient-facing encounters within a determination period (September 1 – August 31 of the previous years). Groups are deemed non-patient facing at the Taxpayer Identification Number (TIN) level if 75% or more ECs are considered non-patient facing as individuals. Historically, the majority of anesthesiologists are considered non-patient facing.

Hospital-based
ECs reporting at the individual level are hospital-based if they furnish 75% or more of their professional services in off-campus outpatient hospital, inpatient hospital, on-campus outpatient hospital or emergency room (Place of Service codes 19, 21, 22, 23 respectively) during at least one determination period. A group or TIN is considered hospital-based only if 100% of ECs are hospital-based as individuals.

Ambulatory-Surgical Center (ASC)-based
ECs reporting at the individual level are hospital-based if they furnish 75% or more of their professional services in an ambulatory surgical center (Place of Service code 24) during at least one determination period. A group or TIN is considered hospital-based only if 100% of ECs are hospital-based as individuals.

Small practice
Practices with 15 or fewer clinicians (NPIs) billing under a TIN during the determination period receive a small practice designation. These practices may receive bonus points in the Quality component.

Rural
ECs and groups whose practice is within a zip code is designated as rural per the Health Resources and Services Administration’s (HRSA) Area Health Resource File will receive this special status.

Health Professional Shortage Area (HPSA)
ECs and groups whose practice is within an area designated as a Health Professional Shortage Area (HPSA).