42 CFR § 414.1430 - Qualifying APM participant determination: QP and partial QP thresholds.

---
identifier: "/us/cfr/t42/s414.1430"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 414.1430 - Qualifying APM participant determination: QP and partial QP thresholds."
title_number: 42
title_name: "Public Health"
section_number: "414.1430"
section_name: "Qualifying APM participant determination: QP and partial QP thresholds."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "B"
subchapter_name: "MEDICARE PROGRAM"
part_number: "414"
part_name: "PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES"
positive_law: false
currency: "2026-03-24"
last_updated: "2026-03-24"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302, 1395hh, and 1395rr(b)(l)."
regulatory_source: "55 FR 23441, June 8, 1990, unless otherwise noted."
cfr_part: "414"
---


# 414.1430 Qualifying APM participant determination: QP and partial QP thresholds.

(a) *Medicare Option*—(1) *QP payment amount threshold.* The QP payment amount thresholds are the following values for the indicated payment years:

(i) 2019 and 2020: 25 percent.

(ii) 2021 and 2022: 50 percent.

(iii) 2023 and 2024: 50 percent.

(iv) 2025: 50 percent.

(v) 2026: 50 percent.

(vi) 2027 and later: 75 percent.

(2) *Partial QP payment amount threshold.* The Partial QP payment amount thresholds are the following values for the indicated payment years:

(i) 2019 and 2020: 20 percent.

(ii) 2021 and 2022: 40 percent.

(iii) 2023 and 2024: 40 percent.

(iv) 2025: 40 percent.

(v) 2026: 40 percent.

(vi) 2027 and later: 50 percent.

(3) *QP patient count threshold.* The QP patient count thresholds are the following values for the indicated payment years:

(i) 2019 and 2020: 20 percent

(ii) 2021 and 2022: 35 percent

(iii) 2023 and 2024: 35 percent.

(iv) 2025: 35 percent.

(v) 2026: 35 percent.

(vi) 2027 and later: 50 percent.

(4) *Partial QP patient count threshold.* The Partial QP patient count thresholds are the following values for the indicated payment years:

(i) 2019 and 2020: 10 percent

(ii) 2021 and 2022: 25 percent

(iii) 2023 and 2024: 25 percent.

(iv) 2025: 25 percent.

(v) 2026: 25 percent.

(vi) 2027 and later: 35 percent.

(b) *All-Payer Combination Option*—(1) *QP payment amount threshold.*

(i) The QP payment amount thresholds are the following values for the indicated payment years:

(A) 2021 through 2026: 50 percent.

(B) 2027 and later: 75 percent.

(ii) To meet the QP payment amount threshold under this option, the eligible clinician must also meet a 25 percent QP payment amount threshold under the Medicare Option.

(2) *Partial QP payment amount threshold.* (i) The Partial QP payment amount thresholds are the following values for the indicated payment years:

(A) 2021 through 2026: 40 percent.

(B) 2027 and later: 50 percent.

(ii) To meet the QP payment amount threshold under this option, the eligible clinician must also meet a 20 percent Partial QP payment amount threshold under the Medicare Option.

(3) *QP patient count threshold.* (i) The QP patient count thresholds are the following values for the indicated payment years:

(A) 2021 through 2026: 35 percent.

(B) 2027 and later: 50 percent.

(ii) To meet the QP patient count threshold under this option, the eligible clinician must also meet a 20 percent QP patient count threshold under the Medicare Option.

(4) *Partial QP patient count threshold.* (i) The Partial QP patient count thresholds are the following values for the indicated payment years:

(A) 2021 through 2026: 25 percent.

(B) 2027 and later: 35 percent.

(ii) To meet the Partial QP patient count threshold under this option, the eligible clinician group or eligible clinician must also meet a 10 percent QP patient count threshold under the Medicare Option.

[81 FR 77537, Nov. 4, 2016, as amended at 86 FR 65681, Nov. 19, 2021; 87 FR 70230, Nov. 18, 2022; 88 FR 79539, Nov. 16, 2023; 89 FR 98564, Dec. 9, 2024]