The Quality Payment Program's Merit-Based QPP Incentive Payment System (MIPS 2022), which is the program's default participation pathway, will be taken advantage of by the vast majority of surgeons who sign up for the program. In order to avoid a payment penalty in 2024 based on their MIPS performance in 2022, surgeons need to earn a total of 75 points on the MIPS scale. This goal must be met in order to qualify. If participants in the MIPS program achieve an extraordinary level of performance and above the distinct exceptional performance threshold, which will be 89 points for the year 2022, they will be entitled to an additional positive payment adjustment that will come from a separate pool of cash. The year 2022 was chosen as the starting point for this level.