OMB control number
Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey for the Merit-Based Incentive Payment System (MIPS) (CMS-10450)
OMB 0938-1222 · HHS/CMS.
Section 1848(q) of the Social Security Act, as amended by section 101 of the Medicare Access and CHIP Reauthorization Act of 2015, authorizes the establishment of a Merit-based Incentive Payment System (MIPS) for eligible clinicians. Beginning in CY 2017, eligible clinicians are required to collect and submit data on four performance categories to CMS (quality, cost, advancing care information and improvement activities). This program replaces and consolidates portions of the PQRS, Value-based Modifier, and the Medicare EHR Incentive Program. The Act also establishes a second track, Advanced Alternative Payment Models (APMs) for clinicians to participate in instead of MIPS. The CAHPS survey information is used for quality reporting to collect data on fee-for-service Medicare beneficiaries’ experiences of care with eligible clinicians participating in MIPS, the Physician Compare website, and annual statistical reports describing MIPS data for all MIPS eligible clinicians.
The latest form for Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey for the Merit-Based Incentive Payment System (MIPS) (CMS-10450) expires 2026-07-31 and can be found here.
Document Name |
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Form and Instruction |
Form and Instruction |
Form |
Supporting Statement B |
Supporting Statement A |
Supplementary Document |
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Approved with change |
Revision of a currently approved collection | 2024-02-15 | |
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Approved with change |
Revision of a currently approved collection | 2021-07-21 | |
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Approved without change |
Revision of a currently approved collection | 2021-02-26 | |
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Approved without change |
Extension without change of a currently approved collection | 2018-12-13 | |
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Comment filed on proposed rule and continue |
Revision of a currently approved collection | 2018-09-11 | |
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Approved with change |
Revision of a currently approved collection | 2017-12-20 | |
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Comment filed on proposed rule and continue |
Revision of a currently approved collection | 2017-08-01 | |
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Approved with change |
Revision of a currently approved collection | 2016-11-02 | |
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Comment filed on proposed rule and continue |
Revision of a currently approved collection | 2016-06-07 | |
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Approved with change |
New collection (Request for a new OMB Control Number) | 2013-03-22 |
CAHPS for MIPS Survey Beneficiary Participation
Federal Enterprise Architecture: Health - Health Care Services
| Form CMS-10450 | Mail Survey | Fillable Fileable | Form |
| Form CMS-10450 | CAHPS for MIPS CATI Script | Fillable Fileable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.