CMS has proposed ending the traditional merit-based Incentive payment system reporting and requiring spine surgeons and other clinicians to report through MIPS Value Pathways starting in 2029. The change would reshape how spine surgeons are measured, even though none of CMS’ current MVPs is built specifically for spine surgery.
A final decision is expected this fall in the 2027 Medicare physician fee schedule final rule.
What CMS proposed
In the 2027 physician fee schedule proposed rule, released July 14, CMS proposed sunsetting traditional MIPS and making MVPs mandatory beginning with the 2029 performance year, which affects 2031 payments.
MVPs are specialty-specific sets of measures and activities. CMS said the updated MVP options would give about 98% of specialties a relevant way to report. Virtual groups would also be allowed to report MVPs starting in 2029.
The rule would also add a new core measure requirement for both traditional MIPS and MVP participants, with a proposed exemption for small practices. CMS proposed keeping the performance threshold at 75 points through the 2028 performance year. Clinicians who score below the threshold face negative payment adjustments of up to 9%.
The proposal comes alongside cuts to the conversion factor, which would fall from $33.4009 to $32.8409 for clinicians who are not qualifying APM participants. Public comments closed Sept. 14.
2025 scores set 2027 payments
The newly released 2025 final scores determine the MIPS payment adjustments clinicians and group practices will receive in 2027.
Clinicians who believe their score or adjustment was calculated incorrectly can request a targeted review. The window opened with the release of final scores and closes 30 days after the payment adjustments are released. Common reasons to file include:
- Data submitted under the wrong taxpayer identification number or national provider identifier
- A clinician with qualifying APM participant status who shouldn’t receive a MIPS adjustment
- Performance categories that weren’t automatically reweighted despite qualifying extreme and uncontrollable circumstances
Clinicians can request a review by signing in to the QPP website with the same credentials used to submit 2025 data. CMS generally requires supporting documentation, and a CMS representative will follow up on what’s needed.
What it means for spine surgeons
Spine surgeons don’t have an MVP built specifically for their specialty among the 27 available in 2026. Instead, they would likely report through broader pathways that include spine measures.
The Surgical Care MVP includes outcome measures for back pain and leg pain after lumbar surgery, along with a cost measure for one- to three-level lumbar spine fusion for degenerative disease. The Musculoskeletal Care MVP includes functional status measures for low back and neck impairments.
The shift could change how spine surgeons are compared. In traditional MIPS, spine surgeons can be benchmarked against clinicians in very different specialties on broad measures. MVPs are designed to compare clinicians on measures specific to their care.
The timing also overlaps with CMS’ mandatory Ambulatory Specialty Model, which brings low back pain care under a new payment model starting in 2027.
What to watch
CMS is expected to release the 2027 physician fee schedule final rule this fall. It will show whether the agency keeps the 2029 timeline after pushback from physician groups.
Practices that want to test an MVP before any mandate can still register to report one for the 2026 performance year through Nov. 30. Clinicians who report both an MVP and traditional MIPS receive the higher of the two scores.
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