Skip to content

MIPS Cost Performance Category

  • Our system captures 25 essential measures from claims data, including 15 episode-based measures, 6 acute-episode measures, and 2 chronic care episode measures
  • Enjoy quality care made easy with our automated system
  • Track yourMIPS Cost performance over a full calendar year with our system's Total Category Score calculation, which averages the score of all applicable measures
  • Stay ahead of the curve with quarterly performance previews through MIPSpro Enterprise or Healthmonix MIPS Cost Analytics.
30%
of MIPS Performance Score

Need to know for 2023 MIPS Cost Reporting

  • If a clinician or group does not meet the minimum number of cases for any of the cost measures, the cost category will be reweighted.
  • The most common applicable cost measures are Total Per Capita Cost (TPCC) and Medicare Spending Per Beneficiary (MSPB).
  • CMS calculates a single, national benchmark for each cost measure based on the performance year. All MIPS-eligible clinicians who meet or exceed the minimum number of cases for a measure are included in the same benchmark.
  • Cost Performance is 30% of your final 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.

 
2023 MIPS Cost Measures

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

 Asthma/Chronic Obstructive Pulmonary Disease (COPD)

Procedural

Chronic Condition

Colon and Rectal Resection 

Diabetes

Intracranial Hemorrhage or Cerebral Infarction

Procedural

Chronic Condition

Acute Inpatient Medical Condition

Melanoma Resection

Knee Arthroplasty

Procedural

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)

Sepsis

Acute Inpatient Medical Condition

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 quarterly.

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, webinar: MIPS Cost Category - Back to the Basics to understand the basics of MIPS Cost reporting , learn how to to identify all Cost measures and prepare for 2022 Cost reporting.