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MIPS Cost Performance Category


2021 MIPS

  • 20 measures, including 2 overall primary care measures,  and 18 episode-based measures, are automatically captured through claims data.
  • Total Category Score is averaged from the score of all applicable measures.
  • Measure performance is tracked over a full calendar year.
  • Clinicians can preview 2018-2021 performance on a quarterly basis via MIPSpro Enterprise or through Healthmonix MIPS Cost Analytics .
20%
of MIPS Composite Performance Score

No changes from 2020 MIPS Cost Reporting

  • The Medicare Spending Per Beneficiary (MSPB) and Total Per Capita Cost (TPCC) measures were revised in 2020 and remain unchanged.
  • Eighteen episode-based measures remain part of the Cost performance category score.

MIPS Cost Final Score

To calculate Cost, CMS will assign 1 to 10 achievement points to each scored measure shown in the table below, based on the clinician or group’s performance compared to the performance year benchmark. Therefore, achievement points for each measure depend on the decile range in which you or your group’s performance falls. 

The maximum score for the category is 100%. Additional bonus points will not be applied to a perfect achievement score.

MEASURE TOPIC

MEASURE TYPE

Medicare Spending Per Beneficiary (MSPB)

All patient

Total Per Capita Costs (TPCC)

All patient

Routine Cataract Removal with Intraocular Lens (IOL) Implantation

Procedural

Intracranial Hemorrhage or Cerebral Infarction

Acute Inpatient Medical Condition

Knee Arthroplasty

Procedural

Elective Outpatient Percutaneous Coronary Intervention (PCI)

Procedural

Simple Pneumonia with Hospitalization

Acute Inpatient Medical Condition

Revascularization for Lower Extremity Chronic Critical Limb Ischemia

Procedural

Screening/Surveillance Colonoscopy

Procedural

ST-Elevation Myocardial Infarction (STEMI) with Percutaneous Coronary Intervention (PCI)

Acute Inpatient Medical Condition

Renal or Ureteral Stone Surgical Treatment

Procedural

Non-Emergent Coronary Artery Bypass Graft (CABG)

Procedural

Lumpectomy, Partial Mastectomy, Simple Mastectomy

Procedural

Lower Gastrointestinal Hemorrhage Measure Cost Measure

Acute Inpatient Medical Condition

Lumbar Spine Fusion for Degenerative Disease, 1-3 Levels

Procedural

Inpatient Chronic Obstructive Pulmonary Disease (COPD) Exacerbation

Acute Inpatient Medical Condition

Hemodialysis Access Creation

Procedural

Femoral or Inguinal Hernia Repair

Procedural

Elective Primary Hip Arthroplasty

Procedural

Acute Kidney Injury Requiring New Inpatient Dialysis

Procedural

key benefits

Healthmonix MIPS Cost Analytics are the next big thing in Cost tracking, optimization and revenue-generating insights.

See total Medicare spend, even outside of your network.

Access updated claims data every 90 days, instead of 18 months after-the-fact.

Better impact your MIPS Cost score.

 Learn how MIPS Cost Analytics can help you achieve your revenue goals and improve care.

Do you understand how CMS calculates Cost?

Check out our free, instructional videos to understand the basics of MIPS Cost reporting , learn how to to identify all Cost measures and prepare for 2021 Cost reporting.


Stay up to date with the latest news regarding MACRA and MIPS.

The Healthmonix Advisor is a free weekly news source, connecting you to the latest updates in the value-based care industry.