CROSSWALK Appendix D: 2025 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations

All-Payer QP Data Submission Form
CY 2023 Final versus CY 2024 Final
Burden impact: The changes to this form reflect policies in the CY 2024 Physician Fee
Schedule (PFS) Final Rule for the Quality Payment Program. There are no impacts to burden
as a result of these changes.
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Change #1
Location: Page 1, Line 21
Reason for Change:
Update threshold levels
CY 2024 Final Rule text:

Payment Amount Threshold Scores
Performance Year

2023 and beyond
Total

QP Payment Amount Threshold

75%

2023 and beyond
Medicare
Minimum
25%

Partial QP Payment Amount Threshold

50%

20%

Performance Year

2025 and beyond
Total

QP Payment Amount Threshold

75%

2025 and beyond
Medicare
Minimum
25%

Partial QP Payment Amount Threshold

50%

20%

CY 2025 Final Rule text:

Payment Amount Threshold Scores

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Change #2
Location: Page 1, Line 28
Reason for Change:
Update threshold levels
CY 2024 Final Rule text

Patient Count Threshold Scores

Performance Year

2024 and beyond
Total

QP Patient Count Threshold

50%

2024 and beyond
Medicare
Minimum
20%

Partial QP Patient Count Threshold

35%

10%

Performance Year

2025 and beyond
Total

QP Payment Amount Threshold

75%

2025 and beyond
Medicare
Minimum
25%

Partial QP Payment Amount Threshold

50%

20%

CY 2025 Final Rule text:

Payment Amount Threshold Scores

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Change #3
Location: Page 2, Line 25
Reason for Change:
Update participating States
CY 2024 Final Rule text:

XIX Table:
State of Primary Practice
Massachusetts
Ohio
Tennessee
Washington

County of Primary Practice
All Counties
All Counties
All Counties
All Counties

CY 2025 Final Rule text:

XIX Table:
State of Primary Practice
Ohio
Tennessee
Washington

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Change #4:

County of Primary Practice
All Counties
All Counties
All Counties

Location: Page 6, Line 5
Reason for Change:
Year updated.
CY 2024 Final Rule text:
2024
CY 2025 Final Rule text:
2025
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Change #5
Location: Page 6, Line 28
Reason for Change:
Year updated.
CY 2024 Final Rule text:
January 1, 2024-June 30, 2024
CY 2025 Final Rule text:
January 1, 2025-June 30, 2025
*****
Change #6:
Location: Page 7, Line 26
Reason for Change:
Year updated.
CY 2024 Final Rule text:
January 1, 2024-June 30, 2024
CY 2025 Final Rule text:
January 1, 2025-June 30, 2025
*****
Change #6:
Location: Page 7, Line 42
Reason for Change:
Year updated.
CY 2024 Final Rule text:
January 1, 2024-June 30, 2024
CY 2025 Final Rule text:
January 1, 2025-June 30, 2025