---
kind: "section"
citation: "42 C.F.R. § 414.1430"
title: "42"
number: "414.1430"
heading: "Qualifying APM participant determination: QP and partial QP thresholds."
url: "https://uscodex.org/cfr/42/414.1430"
---

# §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.

## Notes

### Amendments

[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]

### Source

Source: 81 FR 77537, Nov. 4, 2016, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302, 1395hh, and 1395rr(b)(l).

### Source

Source: 55 FR 23441, June 8, 1990, unless otherwise noted.

### Amendments

[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]