QPP is the Quality Payment Program. For a 2026 Medicare payment comparison, the relevant labels are usually QP (qualifying APM participant) and non-QP. The comparison is a conversion-factor scenario, not a different CPT schedule.
To isolate the policy effect, keep the CPT code, work RVU, practice expense RVU, malpractice RVU, facility setting, and locality fixed. Change only the conversion factor.
2026 QP and non-QP inputs
| Scenario | Calculator conversion factor | Rounded public value |
|---|---|---|
| Non-QP | USD 33.4009 | USD 33.40 |
| QP | USD 33.5675 | USD 33.57 |
The rounded figures are summarized in the CMS CY 2026 MPFS final-rule fact sheet. The calculator uses additional decimal places for reproducible arithmetic.
What must stay constant
- The CPT or HCPCS code.
- The facility or non-facility practice-expense selection.
- The Work, PE, and MP GPCI values for the same Medicare locality.
- The RVU data year.
- The service volume when projecting an annual difference.
If any of these inputs changes between scenarios, the result combines QP status with another variable and cannot be described as the QP-versus-non-QP effect alone.
Controlled calculation
Adjusted total RVU =
(Work RVU x Work GPCI)
+ (Selected PE RVU x PE GPCI)
+ (MP RVU x MP GPCI)
Non-QP estimate =
Adjusted total RVU x USD 33.4009
QP estimate =
Adjusted total RVU x USD 33.5675For a code-level result, use the RVU Calculator and record the locality and setting. The calculator should show the status assumption instead of silently treating QP as the default.
Worked example
Assume the same selected code and locality produce an adjusted total RVU of 2.50:
| Scenario | Calculation | Estimated payment |
|---|---|---|
| Non-QP | 2.50 x USD 33.4009 | USD 83.50 |
| QP | 2.50 x USD 33.5675 | USD 83.92 |
| Difference per 2.50 adjusted RVUs | 2.50 x USD 0.1666 | USD 0.42 |
This is an illustrative calculation. It is not a code-specific fee quote and does not include claim-level adjustments, payer edits, sequestration, modifiers, or commercial contract terms.
Do not confuse payment with compensation
QP status changes the modeled Medicare conversion-factor scenario. It does not automatically change a physician’s employment compensation. A contract may use credited work RVUs, a threshold, and a negotiated dollars-per-wRVU rate. Review those terms with the salary estimator or the written agreement rather than substituting the Medicare CF.
Practical workflow
- Select the code after the applicable coding and documentation review.
- Choose facility or non-facility PE and record the data year.
- Identify the Medicare locality and its component GPCI values.
- Calculate adjusted total RVU.
- Run non-QP and QP scenarios only when the comparison is needed.
- Confirm the applicable QP status through the relevant CMS or organizational record before using the QP result operationally.
For the broader conversion-factor explanation, see 2026 Medicare Conversion Factor. For the step-by-step RVU workflow, see How to Calculate wRVU Step by Step.
FAQ
Is QPP the same as QP?
No. QPP is the program. QP is a qualifying participant status within the Advanced APM pathway; non-QP is the other modeled status in this comparison.
Does QP status change the RVU components?
No. The code-level RVU and GPCI inputs stay separate. The modeled conversion factor changes.
Should QP be assumed when status is unknown?
No. Use a labeled non-QP baseline and confirm status before relying on a QP scenario.