Faster project delivery and the infusion of contractor knowledge into design are the primary drivers for choosing construction manager/general contractor (CM/GC) project delivery. This paper focuses on the use of qualifications-based (QBS) and best-value (BV) procurement approaches, how and why agencies use each, and their associated opportunities and obstacles. Data for this study were obtained from a majority of federally funded CM/GC projects completed between 2005 to 2015. The findings are that BV and QBS projects characteristics and performance have no statistically significant difference. The choice of BV or QBS coincides with the agency’s CM/GC stage of organizational development and influences of non-agency stakeholders on the CM/GC process. When agencies and the local industry are new to CM/GC, they were found to use BV as it is closer to the traditional procurement culture and it is perceived to result in a fair market project price. Alternatively, agencies and local industry partners with an established history of using CM/GC were found to choose QBS. The low level of design at the time of procurement, means that assumptions relating to risk, production rates, materials sources, etc. may be too preliminary to secure a reliable price. The use of BV procurement was found to pose a risk to innovation and increase negotiation efforts. Qualitative trends from the project data, interviews and literature point to agencies using QBS for the majority of CM/GC project and BV on CM/GC projects with lesser complexity or more highly developed designs at the time of selection.