Appendix C 2026 Submission Form for Eligible Clinician and APM Enti

Quality Payment Program (QPP)/Merit-Based Incentive Payment System (MIPS) (CMS-10621)

Appendix C 2026 Eligible Clinician Initiated Submission Form

CY 2026 Performance Period/2028 MIPS Payment Year

OMB: 0938-1314