How MIPS Scores Are Calculated in 2026: Quality, Cost, IA, and PI Explained

Your MIPS final score is a single number from 0 to 100, but it is built from four separate categories, each weighted differently and each scored on its own logic. Understanding how the pieces fit together is what lets you spend effort where it actually moves your score. Here is how the 2026 calculation works, category by category.

The category weights

For 2026, CMS kept the weights unchanged from 2025:

Quality: 30 percent Cost: 30 percent Promoting Interoperability: 25 percent Improvement Activities: 15 percent

Each category produces a percentage score from 0 to 100. CMS multiplies each by its weight, adds the results, applies any bonuses, and arrives at your final score. That score is compared to the 75-point threshold to set your payment adjustment.

Quality (30 percent)

You report six measures, including at least one outcome or high-priority measure, or you report a full specialty measure set. Each measure is scored against a benchmark, earning 1 to 10 points, as long as you meet two conditions: 75 percent data completeness across all payers and at least 20 cases in the denominator.

Miss those conditions and the measure scores poorly. A small practice (15 or fewer clinicians) still earns 3 points for a measure that misses completeness. A larger practice earns zero. CMS uses historical benchmarks where available, with flat or topped-out benchmarks for certain measures that have limited room to improve.

Cost (30 percent)

This is the category you do not submit. CMS calculates it from Medicare Part B claims using 35 cost measures, including the Total Per Capita Cost and Medicare Spending Per Beneficiary measures plus episode-based measures. Each measure requires a minimum number of attributed cases or episodes to be scored. If you do not meet the case minimums on any cost measure, the category is reweighted and its 30 percent shifts to your other categories.

Because cost is claims-driven, your main levers are diagnosis coding accuracy, which drives risk adjustment, and your referral and utilization patterns.

Promoting Interoperability (25 percent)

PI measures how you use certified EHR technology to exchange health information. You report a defined measure set for at least 180 continuous days. The category includes a required Security Risk Analysis, which for 2026 requires a second attestation confirming you implemented security measures to address identified vulnerabilities. Small practices and several special-status clinician types receive automatic reweighting to 0 percent, which redistributes the 25 percent to other categories.

Improvement Activities (15 percent)

You attest to activities performed for at least 90 continuous days. Large practices generally need activities totaling 40 points (typically two medium-weight or one high-weight activity). Small practices and special-status clinicians earn full credit with a single activity. For group reporting, at least 50 percent of clinicians must perform the same activity.

Bonuses that adjust the final score

A few bonuses can lift your score:

• Small practice bonus: 6 points added to the Quality category numerator, as long as you submit at least one quality measure.
• Complex patient bonus: available to clinicians and groups whose average risk score or dual-eligibility ratio is above the median.
• Improvement scoring: up to 10 bonus points in Quality and up to 1 point in Cost for year-over-year improvement.

A simplified example

Suppose a small practice scores 80 percent on Quality, has Cost reweighted because it missed case minimums, earns full Improvement Activities credit, and has PI automatically reweighted. With Cost and PI both reweighted, their 55 percent of weight redistributes to Quality and IA. The exact redistribution depends on which categories are reweighted, but the takeaway holds: when categories drop out, the ones you do report carry more weight, so each point matters more.

The bottom line

Two categories, Quality and Cost, make up 60 percent of your score, and they reward different things. Quality rewards clean data capture on well-chosen measures. Cost rewards accurate coding and efficient utilization. Know which categories you actually report after reweighting, because that tells you where each additional point comes from.