MIPS (Merit-Based Incentive Payment System) is the program that determines whether your neurology practice gets a Medicare payment bonus or penalty in 2028 (based on 2026 performance). At its best, 2026 reporting can earn up to 9% in positive payment adjustment. Here are the 6 Quality measures worth reporting for neurology — and how to set up the rest of your MIPS strategy.
What MIPS is and why it matters in 2026
MIPS scores you 0-100. Above the 75-point threshold earns positive payment adjustments. Below 75 = penalty. The maximum positive adjustment is 9%. Score weighting in 2026: Quality 30%, Cost 30%, Promoting Interoperability 25%, Improvement Activities 15%.
Quality category: how scoring works
Report 6 measures total, including at least 1 outcome or high-priority measure. Each measure scores 0-10 based on performance vs national benchmark. Higher denominator + higher performance = more points. Neurology has a specialty-specific measure set that lets you pick from a defined list.
Measure #009: Anti-Depressant Medication Management
Patients ≥18 with a new diagnosis of MDD treated with antidepressant who remained on it for at least 84 days. Relevant for chronic migraine patients on TCAs/SNRIs. High denominator if you treat chronic pain/migraine.
Measure #047: Care Plan
Patients ≥65 with a documented advance care plan. Universal applicability across neurology — dementia, stroke survivors, MS patients especially. High-priority measure (counts double in some cases).
Measure #130: Documentation of Current Medications
Documented medication reconciliation at each office visit. Easy to score on — most EHRs automate this. Outcome-relevant for patients on biologics/anticonvulsants where adherence matters.
Measure #226: Tobacco Use Screening
Documented tobacco use status + cessation counseling for current users. Most EHRs prompt this. High volume, easy points.
Measure #382: Headache Disorder — Lifestyle Modification Counseling
Migraine patients counseled on lifestyle modifications (sleep, hydration, trigger avoidance). Neurology-specific. Strong measure for headache-heavy practices.
Measure #408: Optimal Asthma Control
Most relevant for multi-specialty groups. Not pure neurology but commonly available if you share an EHR with primary care colleagues. Outcome measure — counts double.
Improvement Activities — the 4 best for neurology
- IA_PSPA_28: Completion of a Telehealth Program (most practices qualify post-2020)
- IA_PCMH_2: Patient-Centered Medical Home recognition (if applicable)
- IA_BMH_2: Behavioral/Mental Health Improvement (counseling for depression in chronic migraine patients counts)
- IA_PM_4: Use Patient Self-Management Tools (for example, headache diary apps)
Promoting Interoperability: minimum reporting bar
Your EHR must be certified 2015 Edition Cures Update. Report on e-Rx, Health Information Exchange, Patient Access (95%+ portal access activated), and Public Health/Clinical Data Registry reporting. Most ONC-certified EHRs auto-handle this.
Cost category: scored automatically
Cost is calculated from Medicare claims data — total cost of care + episode-based costs. Specialty-specific cost measures apply for neurology. You can’t directly report this — it’s calculated from your Medicare claims. Watch for cost outliers and address them with care coordination.
2026 reporting deadlines + submission method
Performance year: Jan 1 – Dec 31, 2026. Submission window: Jan 2 – March 31, 2027. Submit via your EHR’s MIPS module, a registry, or QPP.cms.gov direct portal. Most neurology practices use a Qualified Registry — talk to your EHR vendor about which they support.
Common mistakes neurology practices make in MIPS
- Reporting too few measures. 6 measures total — 5 with at least 1 high-priority. Less and you lose points.
- Picking measures with low denominators. Pick measures where you have 200+ eligible patients to maximize reliability points.
- Not tracking improvement activities. The 15% IA category is easy if you document.
- Letting cost get away. Coordinate care, manage admissions, avoid duplicate testing — cost is now 30% of your score.
Want a free MIPS readiness assessment for your practice? AMS Solutions has helped 40+ neurology practices navigate MIPS reporting since the program started. Call (214) 571-6317 or book a 30-minute review. Don’t miss our free 2026 Neurology CPT Cheat Sheet. State-specific guides: Texas neurology billing | New York neurology billing.
