The Centers for Medicare & Medicaid Services finalized the 2026 Quality Payment Program final rule on Nov. 5, 2025, introducing updates to the quality, cost, improvement activities, and Merit-based Incentive Payment System value pathways (MVP) categories. This rule also includes details on future payment adjustments and the new ambulatory specialty model. Key highlights specific to sleep medicine are analyzed below.

Quality performance category

CMS finalized 190 quality measures for 2026, including:

  • Five newly added measures
  • Ten removed measures
  • Thirty measures with significant revisions

Note: QCDR measures are not included in this finalized measure count.

Cost performance category

To support clinicians as they adapt to new cost measures, CMS has established a two-year informational-only feedback period. During this time, clinicians will receive performance feedback without the scores affecting their MIPS final score, allowing time to identify gaps and improve before the measures become fully effective.

Improvement activities performance category

CMS has retired the achieving health equity subcategory and introduced the new advancing health and wellness subcategory.

Merit-based Incentive Payment System (MIPS) value pathways (MVPs)

For 2026, CMS has finalized 27 MVPs.

New MVPs

  • Diagnostic radiology
  • Interventional radiology
  • Neuropsychology
  • Pathology
  • Podiatry
  • Vascular Surgery

Modified MVPs

CMS updated several existing MVPs, including:

  • Complete ophthalmologic care
  • Dermatological care
  • Gastroenterology care
  • Optimal care for patients with urologic conditions
  • Pulmonology care*
  • Surgical care
  • Emergency medicine (adopting best practices and promoting patient safety)
  • Advancing cancer care
  • Advancing care for heart disease
  • Advancing rheumatology patient care
  • Coordinating stroke care
  • Women’s health
  • Lower extremity joint repair
  • Optimal kidney health
  • Anesthesia (patient safety and experience)
  • Infectious disorders (including hepatitis C and HIV)
  • Neurological conditions
  • Ear, nose, and throat disorders*
  • Mental health and substance use disorders
  • Rehabilitative support for musculoskeletal care
  • Value in primary care

* The pulmonology care MVP and the ENT MVP include AASM measures Q277 and/or Q279. Members are strongly encouraged to submit under these MVPs.

MIPS payment adjustments

The performance threshold will remain at 75 points through the 2028 performance period/2030 MIPS payment year. This provides continued stability for clinicians planning their reporting strategies.

Ambulatory specialty model (ASM)

Looking ahead, CMS has announced a new mandatory alternative payment model: the ambulatory specialty model (ASM). Launching in 2027, this model will focus on care delivered by select specialists treating Medicare beneficiaries with heart failure and low back pain. More details will be shared as CMS releases further guidance.

Resources

  • The final regulation is available here.
  • The QPP fact sheet is available here.

Members may send questions regarding changes to the Quality Payment Program to quality@aasm.org.