QPP and APM are related policy terms, but they are not interchangeable. The Quality Payment Program (QPP) is the broader Medicare quality framework. An Alternative Payment Model (APM) is one participation path within that framework. For the 2026 RVU payment calculation, the practical question is whether the clinician has confirmed qualifying APM participant (QP) status and therefore which conversion factor applies.
This article explains the payment-model input after the CPT code has been selected. It does not determine QP eligibility, select an APM, or replace the official CMS participation record.
2026 conversion factors
| Payment status | 2026 conversion factor | Use in the calculator |
|---|---|---|
| Non-QP | USD 33.4009 | Default modeling assumption when QP status is not confirmed |
| QP | USD 33.5675 | Use only when qualifying APM participant status is confirmed |
The difference between the two 2026 factors is USD 0.1666 per geographically adjusted total RVU. The conversion factor does not change the CPT code, the RVU components, or the GPCI values.
QPP, APM, and QP in plain language
- QPP: the broader program that includes the Merit-based Incentive Payment System and Advanced APM participation.
- APM: a payment model with its own participation and payment rules.
- QP: a qualifying-participant status that determines whether the higher 2026 conversion factor applies under the modeled scenario.
Being familiar with QPP or participating in an APM is not, by itself, a reason to select the QP factor. Confirm the relevant status through the official CMS record. When status is unknown, label the result as non-QP rather than silently using the higher factor.
The payment formula does not change
QP status changes the final conversion factor. The rest of the Medicare payment workflow remains the same:
Adjusted total RVU =
(Work RVU x Work GPCI)
+ (Selected PE RVU x PE GPCI)
+ (MP RVU x MP GPCI)
Payment estimate =
Adjusted total RVU x Selected Conversion FactorKeep the CPT code, facility or non-facility setting, locality, data year, and RVU source constant when comparing QP and non-QP scenarios. Otherwise the difference cannot be attributed to the payment-model status.
Controlled example
Assume a selected code produces an adjusted total RVU of 2.50 after the RVU components and GPCI values have already been applied:
| Scenario | Adjusted total RVU | Conversion factor | Estimated payment |
|---|---|---|---|
| Non-QP | 2.50 | USD 33.4009 | USD 83.50 |
| QP | 2.50 | USD 33.5675 | USD 83.92 |
The example changes only the conversion factor. It does not imply that a specific clinician qualifies as a QP or that a payer will remit the displayed amount.
Run the comparison with the same code and locality
- Select the CPT or HCPCS code supported by the documentation and coding process.
- Choose the facility or non-facility PE setting.
- Select the Medicare payment locality and retain its Work, PE, and MP GPCI values.
- Run the non-QP scenario, then run the QP scenario with every other input unchanged.
- Keep the participant status and data year in the copied result.
For a concrete code-level comparison, use the CPT 99213 non-QP view and the CPT 99213 QP view. The CMS Advanced APM reference is the authority for participation rules.
QP status is separate from physician compensation
Medicare payment uses the selected conversion factor and all three RVU components after GPCI adjustment. A physician compensation plan commonly uses work RVU credit and a negotiated dollars-per-wRVU rate. The QP factor should not be substituted for a contract rate, and the contract rate should not be used as a Medicare conversion factor.
What this page does not decide
- It does not determine whether a clinician is a QP.
- It does not select an APM or interpret a participation agreement.
- It does not determine the correct CPT code or place of service.
- It does not predict a commercial payer’s allowed amount or remittance.
FAQ
Should I use the QP factor by default?
No. Use the non-QP factor unless qualifying APM participant status has been confirmed for the scenario being modeled.
Does QP status change the work RVU?
No. It changes the conversion-factor assumption used after the geographically adjusted total RVU has been calculated.
Can a QP conversion-factor estimate be used for compensation?
Not automatically. Compensation is governed by the written agreement and may use a separate dollars-per-wRVU rate.