MIPS Improvement Activities: Scoring, Attestation & Special-Status Rules

MIPS Improvement Activities (IA) is the attestation-based practice-improvement performance category under the Merit-Based Incentive Payment System (MIPS), accounting for 15 percent of the 2026 MIPS final score. Clinicians attest to performing activities for a minimum of 90 continuous days. 

Standard clinicians attest to 2 activities; small-practice, rural, non-patient-facing, and HPSA clinicians attest to 1 activity for full credit. Activities no longer carry high or medium weights.

What are MIPS Improvement Activities?

MIPS Improvement Activities (IA) are practice-improvement attestations clinicians complete to earn points toward the IA performance category of the Merit-Based Incentive Payment System (MIPS). IA is one of four MIPS performance categories, alongside Quality, Cost, and Promoting Interoperability. The IA category carries a 15 percent weight for the 2026 performance year.

IA is the smallest weight component but the lowest-lift category to complete. Attestation alone earns credit, with no continuous measure-level data collection required. CMS finalized more than 100 activities for 2026 across seven active subcategories.

How do Improvement Activities contribute to the MIPS final score?

The IA category contributes up to 15 points to the MIPS final score, calculated by multiplying the clinician’s IA category percent score by the 15 percent category weight. The four MIPS categories combine as Quality 30 percent, Cost 30 percent, Promoting Interoperability 25 percent, and IA 15 percent, totaling a final score of 0 to 100.

A clinician must clear the 75-point performance threshold in 2026 to avoid the -9 percent Medicare Part B penalty. IA is often the easiest category to maximize, which makes it a strategic anchor for clinicians starting below the threshold. CMS maintains the 75-point threshold through the 2028 performance year.

How many Improvement Activities does CMS publish for 2026?

CMS finalized more than 100 Improvement Activities for the 2026 performance year. The year-over-year change includes 3 new activities, 7 modified activities, and 8 removed activities, plus 4 additional activities previously finalized for removal effective 2026.

CMS finalized the 2026 inventory in the Physician Fee Schedule Final Rule published November 5, 2025. The full activity list with subcategories appears on the 2026 MIPS Improvement Activities list page. 

Did MIPS Improvement Activities change for 2026?

Yes. CMS finalized 3 new Improvement Activities, removed 8, substantively modified 7, and replaced the Achieving Health Equity (AHE) subcategory with a new Advancing Health and Wellness (AHW) subcategory for the 2026 performance year. The total inventory remains above 100 activities. 

How are MIPS Improvement Activities scored in 2026?

MIPS Improvement Activities use a flat-point scoring model in 2026, with each activity worth 20 points and a maximum IA category score of 40 points. Beginning in the 2025 performance year, CMS removed the high-weighted and medium-weighted designations. All activities now carry equal point value.

A standard MIPS clinician reaches the 40-point maximum by attesting to 2 activities. Small-practice and other special-status clinicians reach the maximum by attesting to 1 activity. The IA category percent score then feeds the 15 percent category weight.

How many activities earn full Improvement Activities credit?

Standard MIPS clinicians earn full IA credit by attesting to 2 activities performed for at least 90 continuous days. Special-status clinicians earn full credit with 1 activity. The special statuses are small practice, rural, non-patient-facing, and Health Professional Shortage Area (HPSA).

Partial attestation earns partial credit. A standard clinician who attests to 1 of the 2 required activities earns 50 percent of the IA category score, which equals 7.5 of the 15 possible final-score points. Attesting to more than the required number of activities does not increase the category score.

What is each Improvement Activity worth in 2026?

Each MIPS Improvement Activity is worth 20 points in 2026, regardless of subcategory or scope. The IA category caps at 40 points, which equals a 100 percent category score. CMS sets these values in the annual Physician Fee Schedule Final Rule.

A standard clinician needs 2 activities at 20 points each to reach the 40-point cap. The flat-point model replaced the prior system, where activities earned either 20 points (high) or 10 points (medium). The change reduced selection complexity for clinicians choosing activities.

Are Improvement Activities still high-weighted or medium-weighted?

No. CMS removed the high-weighted and medium-weighted designations starting with the 2025 performance year. All Improvement Activities now carry the same point value, and no activity ranks above another for scoring purposes. Clinicians select activities by relevance to their workflow, not by weight tier. Many third-party pages still reference the retired high-and-medium model, which no longer applies in 2026.

How do clinicians attest to MIPS Improvement Activities?

MIPS Improvement Activities are attestation-based: clinicians declare that they performed selected activities for at least 90 continuous days during the 2026 performance year. No measure-level data submission is required. Standard clinicians attest to 2 activities; special-status clinicians attest to 1.

Each activity must run for a minimum of 90 continuous days within the calendar year. The last possible 90-day start date is October 3, 2026. Group reporting carries an added rule: at least 50 percent of clinicians in the group must perform the same activity during the same window.

How many activities must a clinician attest?

Standard MIPS clinicians must attest to 2 Improvement Activities to earn the full 40-point IA category score. Special-status clinicians attest to 1 activity of any type for full credit. The special statuses are small practice, rural, non-patient-facing, and HPSA.

Clinicians can attest to additional activities, but the IA category caps at 40 points. Extra activities earn no additional category-level credit. Most practices select 2 activities that align with existing workflows to limit added administrative cost.

What is the 90-day continuous attestation period?

Each MIPS Improvement Activity must be performed for a minimum of 90 continuous days within the 2026 calendar year. Clinicians choose any 90-day window that ends by December 31, 2026. The 90-day window is the minimum; clinicians can perform an activity longer.

The last possible 90-day start date is October 3, 2026. Starting later means the window cannot be completed by year-end, and the clinician forfeits IA credit for that activity. For group reporting, all attesting clinicians perform the activity during the same 90-day window. 

What is the 50% group-attestation rule?

For group reporting at the TIN level, MIPS Improvement Activities require at least 50 percent of the MIPS-eligible clinicians in the group to perform the same activity during the same continuous 90-day period. In a group of 20 eligible clinicians, at least 10 must perform the attested activity.

Groups retain documentation showing which clinicians participated and during which window. Clinician rosters with start and end dates per activity satisfy this requirement. Virtual groups apply the same 50 percent rule across the virtual group’s combined clinician roster.

Can a single clinician’s attestation cover the whole group?

No. Under group reporting, at least 50 percent of MIPS-eligible clinicians in the group must perform the same activity during the same 90-day window. A single clinician’s attestation does not satisfy the group requirement, even when the rest of the group holds special status. The group either meets the 50 percent threshold or earns zero credit for that activity.

What special-status rules reduce the Improvement Activities requirement?

MIPS Improvement Activities apply a reduced-requirement rule for special-status clinicians: these clinicians attest to 1 activity instead of 2 to earn the full 40-point IA category score. The rule lets eligible clinicians reach the maximum with half the standard activity count.

The reduced requirement applies to clinicians designated small practice (15 or fewer eligible clinicians), rural, non-patient-facing, or HPSA. The rule is specific to the IA category and does not change Quality, Cost, or Promoting Interoperability scoring.

Which special statuses qualify for the reduced Improvement Activities requirement?

Four MIPS special statuses reduce the Improvement Activities requirement from 2 activities to 1:

1. Small practice – a TIN with 15 or fewer eligible clinicians.
2. Rural – a practice delivering the majority of services in a ZIP code designated rural under CMS’s rural definition.
3. Non-patient-facing – a clinician billing 100 or fewer patient-facing encounters per year, or a group where 75 percent of clinicians meet that threshold.
4. Health Professional Shortage Area (HPSA) – a practice located in a federally designated HPSA per the Health Resources and Services Administration (HRSA).

CMS applies the reduced requirement automatically based on TIN-level status determination. No separate application is required.

How does the reduced-requirement rule work?

The reduced-requirement rule lets special-status clinicians earn the full 40-point IA category score by attesting to a single activity. A standard clinician needs 2 activities at 20 points each. A special-status clinician’s single activity earns full category credit.

The practical effect is a 50 percent reduction in attestation burden. A small-practice clinician selects 1 activity that fits an existing workflow, performs it for 90 continuous days, and reaches a 100 percent IA category score. The category percent score still caps at 100 percent regardless of how many activities the clinician completes.

Does the reduced IA requirement stack with the small-practice MIPS bonus?

Yes. The IA reduced-requirement rule and the separate small-practice MIPS bonus apply independently. The IA rule lets a small practice reach the full IA category score with 1 activity. The small-practice bonus then adds points to the Quality performance category score, separate from any IA-category math. The two mechanisms operate at different scoring layers and do not cancel each other.

How is the MIPS Improvement Activities score calculated?

The IA category percent score equals total IA points earned divided by the 40-point maximum, multiplied by 100. That percentage is then multiplied by the 15 percent category weight to determine the IA contribution to the MIPS final score.

IA Category Percent Score = (Total IA Points / 40) × 100, capped at 100%

IA Contribution to MIPS Final Score = IA Category Percent Score × 15% weight

Example 1, standard clinician (2 activities): completes 2 activities at 20 points each = 40 IA points. IA category percent score: 40 / 40 × 100 = 100 percent. Contribution to MIPS final score: 100% × 15% = 15 of 15 possible points.

Example 2, special-status clinician (1 activity): completes 1 activity, which earns full category credit = 40 IA points. IA category percent score: 100 percent. Contribution to MIPS final score: 100% × 15% = 15 of 15 possible points from a single activity.

A standard clinician who attests to only 1 of the 2 required activities earns 20 of 40 points, a 50 percent category score, and 7.5 of 15 final-score points.

Patient-Centered Medical Home (PCMH) recognition earns the maximum IA category score automatically, without per-activity attestation. A practice holding PCMH recognition completes IA scoring by default for the entire category. For deeper scenarios, see our worked MIPS IA scoring examples for small practices and groups.

How are MIPS Improvement Activities organized by subcategory?

CMS organizes the 2026 MIPS Improvement Activities into eight subcategories that group activities by improvement focus. The 2026 inventory replaced one subcategory and retained the rest.

1. Advancing Health and Wellness (AHW) – NEW for 2026, replaces the previous Achieving Health Equity (AHE) subcategory. Focuses on chronic and preventive care management for empaneled patients.
2. Care Coordination (CC) – care transitions, referral loops, and post-discharge follow-up.
3. Population Management (PM) – outcomes tracking across a defined population, including registries and panel management.
4. Patient Safety and Practice Assessment (PSPA) – harm reduction, medication safety, infection control, and practice self-assessment.
5. Beneficiary Engagement (BE) – patient involvement in care decisions and self-management.
6. Expanded Practice Access (EPA) – telehealth access, language access, and after-hours availability.
7. Behavioral and Mental Health (BMH) – behavioral health integration, depression management, and substance-use intervention.
8. Emergency Response and Preparedness (ERP) – public-health emergency response and practice continuity.

The 2026 inventory carries the highest activity counts in Population Management and Care Coordination. The AHW subcategory launched with a single activity, IA_AHW_1 (Chronic Care and Preventative Care Management for Empaneled Patients), and will expand in future rules. The full subcategory breakdown lives on the 2026 MIPS Improvement Activities list page.

What changed for MIPS Improvement Activities in 2026?

CMS finalized four MIPS Improvement Activities changes for the 2026 performance year in the Physician Fee Schedule Final Rule published November 5, 2025.

1. Three new IAs added for 2026:

• IA_PM_27 – Improving Detection of Cognitive Impairment in Primary Care.
• IA_PM_28 – Integrating Oral Health Care in Primary Care.
• Patient Safety in Use of Artificial Intelligence (AI) – a new Patient Safety and Practice Assessment activity.

• Eight IAs removed, plus 4 previously finalized for removal effective 2026. The removed activities include several former Achieving Health Equity activities (such as IA_AHE_8, Create and Implement an Anti-Racism Plan) and outdated Care Coordination measures (IA_CC_1 and IA_CC_2).

• Seven existing IAs substantively modified, with updated activity descriptions, performance-period clarifications, or documentation requirements.

• The Achieving Health Equity (AHE) subcategory was removed and replaced with the new Advancing Health and Wellness (AHW) subcategory.

The IA category weight remains 15 percent of the MIPS final score for 2026. The changes affect the activity inventory and subcategory taxonomy, not the category’s contribution to scoring. Many competitor pages still cite pre-2026 activity counts or the retired AHE subcategory.

How does Macralytics support MIPS Improvement Activities selection and attestation?

Macralytics supports MIPS Improvement Activities selection and attestation through a four-step service workflow.

1. Activity audit – review the clinician’s practice workflows to identify the 1 or 2 activities most likely already in place, applying any special-status reduced requirement.
2. 90-day attestation plan – set the start date, documentation cadence, and group roster to meet the 90-day continuous-period and 50 percent group rules.
3. Attestation documentation – assemble workflow logs, training rosters, and meeting minutes that support the attestation in an audit.
4. Submission via Macralytics Qualified Registry – submit IA attestations alongside Quality and Promoting Interoperability data during the CMS submission window.

For the activity-selection method in detail, see how we pick MIPS Improvement Activities.

Do MIPS Value Pathway (MVP) requirements include Improvement Activities?

Yes, with a simplified requirement compared with Traditional MIPS. Each MIPS Value Pathway (MVP) requires the clinician to attest to 1 Improvement Activity from the MVP-specific inventory, regardless of special status. The 90-day continuous-period and 50 percent group-attestation rules apply to MVP IA reporting identically to Traditional MIPS. Practices considering MVP reporting find the single-activity IA requirement attractive given the reduced administrative burden.