This document is a guide detailing the finalized changes to the Merit-based Incentive Payment System (MIPS) for the year 2024. It outlines significant updates that are relevant to various specialties, particularly ophthalmology and dermatology. Key changes include the maintenance of the penalty threshold at 75 points and an increase in the performance period for the Promoting Interoperability (PI) category to 180 consecutive days. The Quality category sees modifications such as an increase in the data completeness threshold to 75% and the removal of certain measures that have reached the end of their lifecycle. Additionally, the guide provides specific updates on quality measures for ophthalmology and dermatology, including clarifications, removals, and new measures introduced. The document serves as a comprehensive reference for understanding the implications of these changes on clinical practice and reporting requirements.