MIPS 2024: 33,093 clinicians scored below the 75-point line
In CMS's MIPS public-reporting file for performance year 2024, released Aug 18, 2026, the 461,358 scored clinicians had a mean final score of 85.62 and a median of 88.00; 33,093 (7.2%) fell below the 75-point performance threshold, which means a negative Medicare payment adjustment in 2026, against 63,799 (13.4%) for 2023.
Key findings
- Mean final score 85.62 in 2024, up from 83.74 in 2023; median 88.00, up from 86.28.
- 33,093 clinicians scored below 75 in 2024, about half the 63,799 of 2023. Of the 356,538 clinicians scored in both years, 31,163 moved from below 75 to 75 or above, and 10,111 moved the other way.
- 4,771 clinicians have a final score of 0 and 32,293 a perfect 100.
- Maine has the highest state mean, 92.93; Wyoming the lowest of the 50 states and D.C., 78.81.
- By primary specialty, emergency medicine scored highest (90.17) and podiatry lowest (65.60, 28.6% below 75).
Research question
How are MIPS final scores spread across the clinicians CMS scored for 2024, how many fell below the line that triggers a payment cut, and how does that differ by state and specialty and from 2023?
Methodology
CMS publishes one row per clinician and reporting source (individual, group, APM entity, virtual group, subgroup) in its Clinician Public Reporting: Overall MIPS Performance file: 520,011 rows for 2024 and 541,334 for 2023. A clinician can appear several times; this study counts each National Provider Identifier once, at the highest final score in the file, giving 461,358 clinicians for 2024 and 477,587 for 2023. The state and specialty tables join each NPI to its practice state and flagged primary taxonomy in the CMS NPPES file of Aug 9, 2026 (459,579 of the 461,358 matched); states and specialties with fewer than 200 and 2,000 scored clinicians are left out of the rankings. The performance threshold is 75 points for both years. Generator: scripts/gen-mips-study.py.
Findings
Most clinicians score between 80 and 100
82.4% of the 461,358 clinicians scored 80 or more in 2024; the middle 80% ran from 75.00 to 98.30. CMS PY 2024 Overall MIPS Performance 22,509 sit at exactly 75.0. CMS assigns a score equal to the threshold when all performance categories are reweighted, for example under the extreme and uncontrollable circumstances policy, and some clinicians earn exactly 75 as well; a score of 75 brings no payment adjustment.
MIPS final scores, performance year 2024
Clinicians by final score band (highest score per NPI)
33,093 clinicians fell below 75
A final score under 75 brings a negative adjustment to Medicare Part B payments two years later, growing as the score falls until it reaches the maximum cut of 9% at a quarter of the threshold (18.75 points) or less. For 2024, 33,093 clinicians (7.2%) were below the line, against 63,799 (13.4%) for 2023. 4,771 scored 0: a clinician who was required to take part and sent no data receives a 0, and with it the full 9% cut. Clinicians who were exempt, for example under the low-volume threshold, have no MIPS score and are not in this file.
Maine highest, Wyoming lowest by state
The mean final score of the clinicians practising in Maine was 92.93 in 2024, and 0.7% of them were below 75. In Wyoming the mean was 78.81 and 16.3% were below 75. Puerto Rico, with 232 scored clinicians, averaged 74.45. The state is the practice address in NPPES, not the state where the clinician's group reported.
By specialty: emergency medicine 90.17, podiatry 65.60
Among the 46 primary specialties with at least 2,000 scored clinicians, emergency medicine had the highest mean, 90.17 (20,853 clinicians), and podiatry the lowest, 65.60, with 28.6% below 75. Emergency physicians and hospitalists can be scored on their hospital's performance (facility-based scoring), so a specialty's mean reflects how its members report as much as how they perform.
Every state, 2024
| Rank | State | Scored clinicians | Mean | Median | Below 75 |
|---|---|---|---|---|---|
| 1 | Maine | 4,653 | 92.93 | 97.93 | 0.7% |
| 2 | Oregon | 5,655 | 91.47 | 94.61 | 5.0% |
| 3 | West Virginia | 4,094 | 90.86 | 95.34 | 4.3% |
| 4 | North Carolina | 12,627 | 89.83 | 94.00 | 5.1% |
| 5 | Minnesota | 9,182 | 89.57 | 89.23 | 1.1% |
| 6 | Georgia | 17,144 | 89.34 | 93.24 | 4.2% |
| 7 | Connecticut | 9,105 | 89.09 | 90.42 | 3.7% |
| 8 | New York | 41,327 | 88.20 | 92.35 | 5.8% |
| 9 | Massachusetts | 7,332 | 87.86 | 91.98 | 7.1% |
| 10 | Hawaii | 1,713 | 87.59 | 90.59 | 7.2% |
| 11 | Washington | 7,839 | 87.46 | 92.83 | 6.3% |
| 12 | South Dakota | 1,571 | 86.68 | 84.78 | 3.8% |
| 13 | Illinois | 18,222 | 86.55 | 88.83 | 6.3% |
| 14 | New Mexico | 3,447 | 86.40 | 89.53 | 5.4% |
| 15 | Wisconsin | 8,071 | 86.04 | 86.20 | 2.7% |
| 16 | California | 42,512 | 86.02 | 88.87 | 8.0% |
| 17 | Kentucky | 9,692 | 85.79 | 87.13 | 5.9% |
| 18 | South Carolina | 7,671 | 85.58 | 84.33 | 3.5% |
| 19 | Utah | 3,127 | 85.39 | 89.77 | 6.2% |
| 20 | Pennsylvania | 24,602 | 85.33 | 84.91 | 4.0% |
| 21 | Idaho | 1,818 | 85.33 | 87.30 | 4.1% |
| 22 | Michigan | 9,352 | 85.25 | 88.14 | 9.7% |
| 23 | New Jersey | 14,072 | 84.82 | 88.40 | 8.9% |
| 24 | Louisiana | 3,859 | 84.75 | 86.98 | 7.6% |
| 25 | North Dakota | 1,820 | 84.75 | 82.73 | 2.4% |
| 26 | Ohio | 17,847 | 84.64 | 84.80 | 5.2% |
| 27 | Virginia | 12,847 | 84.55 | 86.45 | 6.4% |
| 28 | Kansas | 4,615 | 84.54 | 88.34 | 8.5% |
| 29 | Texas | 29,539 | 84.27 | 84.63 | 6.5% |
| 30 | Tennessee | 9,189 | 84.17 | 86.71 | 10.7% |
| 31 | Florida | 33,129 | 83.83 | 87.18 | 9.2% |
| 32 | Alabama | 5,215 | 83.73 | 87.97 | 12.9% |
| 33 | District of Columbia | 1,824 | 83.70 | 82.97 | 5.4% |
| 34 | Alaska | 1,468 | 83.56 | 90.93 | 11.6% |
| 35 | Colorado | 7,249 | 83.45 | 86.32 | 14.2% |
| 36 | Indiana | 7,677 | 83.44 | 86.32 | 13.3% |
| 37 | Rhode Island | 1,104 | 83.37 | 86.17 | 10.2% |
| 38 | Montana | 1,184 | 83.17 | 83.75 | 9.6% |
| 39 | Missouri | 10,627 | 82.97 | 84.20 | 8.0% |
| 40 | Delaware | 1,173 | 82.75 | 86.05 | 10.7% |
| 41 | Arizona | 9,375 | 82.59 | 86.47 | 9.9% |
| 42 | New Hampshire | 3,067 | 82.43 | 79.66 | 7.1% |
| 43 | Maryland | 11,122 | 81.85 | 83.31 | 11.6% |
| 44 | Iowa | 4,558 | 81.77 | 80.50 | 8.2% |
| 45 | Mississippi | 3,176 | 81.72 | 83.94 | 11.1% |
| 46 | Vermont | 325 | 81.64 | 83.39 | 8.6% |
| 47 | Oklahoma | 4,715 | 81.21 | 85.11 | 12.0% |
| 48 | Nebraska | 1,751 | 80.82 | 85.76 | 16.2% |
| 49 | Arkansas | 1,713 | 78.96 | 85.00 | 13.6% |
| 50 | Nevada | 3,383 | 78.96 | 85.15 | 19.2% |
| 51 | Wyoming | 832 | 78.81 | 82.54 | 16.3% |
| 52 | Puerto Rico | 232 | 74.45 | 78.60 | 23.7% |
Specialties with at least 2,000 scored clinicians, 2024
| Primary specialty | Scored clinicians | Mean | Below 75 |
|---|---|---|---|
| Emergency Medicine | 20,853 | 90.17 | 3.1% |
| Hospitalist | 9,098 | 88.74 | 3.0% |
| Physician Assistant | 34,069 | 87.89 | 5.0% |
| Surgical Physician Assistant | 4,404 | 87.79 | 3.7% |
| Medical Physician Assistant | 7,676 | 87.68 | 5.5% |
| Acute Care Nurse Practitioner | 6,407 | 87.63 | 4.1% |
| Critical Care Medicine (Internal Medicine) | 2,104 | 87.41 | 5.3% |
| Adult Health Nurse Practitioner | 5,059 | 87.18 | 4.8% |
| Hematology & Oncology | 5,258 | 87.05 | 5.6% |
| Audiologist | 2,092 | 86.93 | 6.6% |
| Clinical Social Worker | 3,489 | 86.81 | 8.8% |
| Nurse Practitioner | 16,906 | 86.71 | 5.8% |
| Obstetrics & Gynecology | 8,082 | 86.70 | 5.1% |
| Diagnostic Radiology | 15,429 | 86.68 | 4.6% |
| Surgery | 7,682 | 86.66 | 5.2% |
| Radiation Oncology | 2,525 | 86.45 | 4.2% |
| Infectious Disease | 3,284 | 86.20 | 6.4% |
| Cardiovascular Disease | 8,754 | 86.12 | 5.2% |
| Family Nurse Practitioner | 31,278 | 85.98 | 7.5% |
| Medical Oncology | 2,399 | 85.95 | 1.7% |
| Anatomic Pathology & Clinical Pathology | 4,455 | 85.95 | 6.4% |
| Certified Registered Nurse Anesthetist | 15,786 | 85.76 | 10.0% |
| Gastroenterology | 7,253 | 85.75 | 6.3% |
| Psychiatry | 5,992 | 85.68 | 8.0% |
| Rheumatology | 2,723 | 85.65 | 6.5% |
| Family Medicine | 21,026 | 85.60 | 7.9% |
| Interventional Cardiology | 2,977 | 85.60 | 5.3% |
| Ophthalmology | 9,778 | 85.47 | 6.1% |
| Urology | 4,946 | 85.46 | 5.2% |
| Internal Medicine | 26,111 | 85.45 | 8.2% |
| Pulmonary Disease | 5,092 | 85.38 | 7.0% |
| Anesthesiology | 13,047 | 85.12 | 10.0% |
| Endocrinology, Diabetes & Metabolism | 3,183 | 84.83 | 6.9% |
| Neurological Surgery | 2,452 | 84.58 | 6.6% |
| Psychiatric/Mental Health Nurse Practitioner | 3,397 | 84.49 | 11.0% |
| Neurology | 6,459 | 84.38 | 7.3% |
| Nephrology | 3,606 | 83.73 | 10.6% |
| Physical Therapist | 16,332 | 83.50 | 9.0% |
| Dermatology | 7,226 | 83.29 | 9.4% |
| Orthopaedic Surgery | 7,784 | 82.63 | 10.6% |
| Otolaryngology | 3,848 | 81.38 | 10.6% |
| Physical Medicine & Rehabilitation | 3,499 | 81.38 | 11.6% |
| Optometrist | 7,232 | 80.83 | 13.6% |
| Specialist | 3,215 | 77.07 | 17.0% |
| Foot & Ankle Surgery (podiatry) | 3,570 | 70.66 | 23.9% |
| Podiatry | 3,096 | 65.60 | 28.6% |
What this analysis cannot tell us
A MIPS final score measures reporting and performance on CMS's chosen measures for Medicare Part B; it is not a rating of a clinician's care. Group and APM entity scores are shared by every clinician in the group, so one clinician's score often reflects the group's reporting. The public file covers clinicians CMS scored and published; exempt clinicians are absent. CMS's own program-wide averages count every MIPS eligible clinician and may differ from the figures here, which count each NPI once at its highest published score.
Sources
- CMS PY 2024 and PY 2023 Clinician Public Reporting: Overall MIPS Performance (ec_score_file.csv; the 2024 release of Aug 18, 2026): https://data.cms.gov/provider-data/dataset/a174-a962
- CMS National Plan and Provider Enumeration System (NPPES), file of Aug 9, 2026: https://download.cms.gov/nppes/NPI_Files.html