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Cost measures

Our system captures 29 essential measures from claims data, including 15 episode-based measures, 6 acute-episode measures, and 2 chronic care episode measures. Track your MIPS Cost category 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 MIPS Cost Analytics.

What to know for MIPS Cost category reporting

  • If a clinician or group doesn’t meet the minimum number of cases for any cost measures, the Cost category will be re-weighted.
  • 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.
  • The Cost performance category counts 30% of your final score.
Cost measure Type of cost measure Case minimum Measure information form (PDF)Measure codes (xlsx)
Total Per Capita CostPopulation-based (primary care)20PDFxlsx
Medicare Spending Per Beneficiary ClinicianPopulation-base (inpatient care)35PDFxlsx
Elective Outpatient Percutaneous Coronary Intervention (PCI)Episode-based (procedural)10PDFxlsx
Intracranial Hemorrhage or Cerebral InfarctionEpisode-based (acute inpatient medical condition)20PDFxlsx
Knee ArthroplastyEpisode-based (procedural)10PDFxlsx
Revascularization for Lower Extremity Chronic Critical Limb IschemiaEpisode-based (procedural)10PDFxlsx
Routine Cataract Removal with Intraocular Lens (IOL) ImplantationEpisode-based (procedural)10PDFxlsx
Screening/Surveillance ColonoscopyEpisode-based (procedural)10PDFxlsx
ST-Elevation Myocardial Infarction (STEMI) with Percutaneous Coronary Intervention (PCI)Episode-based (acute inpatient medical condition)20PDFxlsx
Acute Kidney Injury Requiring New Inpatient DialysisEpisode-based (procedural)10PDFxlsx
Elective Primary Hip ArthroplastyEpisode-based (procedural)10PDFxlsx
Femoral or Inguinal Hernia RepairEpisode-based (procedural)10PDFxlsx
Hemodialysis Access CreationEpisode-based (procedural)10PDFxlsx
Inpatient Chronic Obstructive Pulmonary Disease (COPD) ExacerbationEpisode-based (acute inpatient medical condition)20PDFxlsx
Lower Gastrointestinal Hemorrhage (at group level only)Episode-based (acute inpatient medical condition)20PDFxlsx
Lumbar Spine Fusion for Degenerative Disease, 1-3 LevelsEpisode-based (procedural)10PDFxlsx
Lumpectomy, Partial Mastectomy, Simple MastectomyEpisode-based (procedural)10PDFxlsx
Non-Emergent Coronary Artery Bypass Graft (CABG)Episode-based (procedural)10PDFxlsx
Renal or Ureteral Stone Surgical TreatmentEpisode-based (procedural)10PDFxlsx
Asthma/Chronic Obstructive Pulmonary Disease (COPD)Episode-based (chronic condition)20PDFxlsx
Colon and Rectal ResectionEpisode-based (procedural)20PDFxlsx
DiabetesEpisode-based (chronic condition)20PDFxlsx
Melanoma ResectionEpisode-based (procedural)10PDFxlsx
SepsisEpisode-based (acute inpatient medical condition)20PDFxlsx
DepressionEpisode-based (chronic condition)20PDFxlsx
Emergency MedicineEpisode-based (care setting)20PDFxlsx
Heart FailureEpisode-based (chronic condition)20PDFxlsx
Low Back PainEpisode-based (chronic condition)20PDFxlsx
Psychoses and Related ConditionsEpisode-based (acute inpatient medical)20PDFxlsx

Licenses are available for the 2024 reporting year.