Our system captures essential measures from claims data, including episode-based measures, acute-episode measures, chronic care episode measures., and population-based cost 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).
- 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) |
| Medicare Spending Per Beneficiary Clinician | Population-based (inpatient care) | 35 | xlsx | |
| Total Per Capita Cost | Population-based (primary care) | 20 | xlsx | |
| Elective Outpatient Percutaneous Coronary Intervention (PCI) | Episode-based (procedural) | 10 | xlsx | |
| Intracranial Hemorrhage or Cerebral Infarction | Episode-based (acute inpatient medical condition) | 20 | xlsx | |
| Knee Arthroplasty | Episode-based (procedural) | 10 | xlsx | |
| Revascularization for Lower Extremity Chronic Critical Limb Ischemia | Episode-based (procedural) | 10 | xlsx | |
| Cataract Removal with Intraocular Lens (IOL) Implantation | Episode-based (procedural) | 10 | xlsx | |
| Screening/Surveillance Colonoscopy | Episode-based (procedural) | 10 | xlsx | |
| Inpatient Percutaneous Coronary Intervention (PCI) | Episode-based (acute inpatient medical condition) | 20 | xlsx | |
| Acute Kidney Injury Requiring New Inpatient Dialysis | Episode-based (procedural) | 10 | xlsx | |
| Elective Primary Hip Arthroplasty | Episode-based (procedural) | 10 | xlsx | |
| Femoral or Inguinal Hernia Repair | Episode-based (procedural) | 10 | xlsx | |
| Hemodialysis Access Creation | Episode-based (procedural) | 10 | xlsx | |
| Inpatient Chronic Obstructive Pulmonary Disease (COPD) Exacerbation | Episode-based (acute inpatient medical condition) | 20 | xlsx | |
| Lower Gastrointestinal Hemorrhage (at group level only) | Episode-based (acute inpatient medical condition) | 20 | xlsx | |
| Lumbar Spine Fusion for Degenerative Disease, 1-3 Levels | Episode-based (procedural) | 10 | xlsx | |
| Lumpectomy, Partial Mastectomy, Simple Mastectomy | Episode-based (procedural) | 10 | xlsx | |
| Non-Emergent Coronary Artery Bypass Graft (CABG) | Episode-based (procedural) | 10 | xlsx | |
| Renal or Ureteral Stone Surgical Treatment | Episode-based (procedural) | 10 | xlsx | |
| Diabetes | Episode-based (chronic condition) | 20 | xlsx | |
| Asthma/Chronic Obstructive Pulmonary Disease (COPD) | Episode-based (chronic condition) | 20 | xlsx | |
| Sepsis | Episode-based (acute inpatient medical condition) | 20 | xlsx | |
| Melanoma Resection | Episode-based (procedural) | 10 | xlsx | |
| Colon and Rectal Resection | Episode-based (procedural) | 20 | xlsx | |
| Psychoses and Related Conditions | Episode-based (acute inpatient medical condition) | 20 | xlsx | |
| Emergency Medicine | Episode-based (care setting) | 20 | xlsx | |
| Low Back Pain | Episode-based (chronic condition) | 20 | xlsx | |
| Heart Failure | Episode-based (chronic condition) | 20 | xlsx | |
| Depression | Episode-based (chronic condition) | 20 | xlsx | |
| Chronic Kidney Disease (CKD) | Episode-based (chronic condition) | 20 | xlsx | |
| End-Stage Renal Disease (ESRD) | Episode-based (chronic condition) | 20 | xlsx | |
| Rheumatoid Arthritis | Episode-based (chronic condition) | 20 | xlsx | |
| Prostate Cancer | Episode-based (chronic condition) | 20 | xlsx | |
| Kidney Transplant Management | Episode-based (chronic condition) | 20 | xlsx | |
| Respiratory Infection Hospitalization | Episode-based (acute inpatient medical condition) | 20 | xlsx |
| Cost measure | Type of cost measure | Case minimum | Measure information form (PDF) | Measure codes (xlsx) |
| Total Per Capita Cost | Population-based (primary care) | 20 | xlsx | |
| Medicare Spending Per Beneficiary Clinician | Population-base (inpatient care) | 35 | xlsx | |
| Elective Outpatient Percutaneous Coronary Intervention (PCI) | Episode-based (procedural) | 10 | xlsx | |
| Intracranial Hemorrhage or Cerebral Infarction | Episode-based (acute inpatient medical condition) | 20 | xlsx | |
| Knee Arthroplasty | Episode-based (procedural) | 10 | xlsx | |
| Revascularization for Lower Extremity Chronic Critical Limb Ischemia | Episode-based (procedural) | 10 | xlsx | |
| Routine Cataract Removal with Intraocular Lens (IOL) Implantation | Episode-based (procedural) | 10 | xlsx | |
| Screening/Surveillance Colonoscopy | Episode-based (procedural) | 10 | xlsx | |
| ST-Elevation Myocardial Infarction (STEMI) with Percutaneous Coronary Intervention (PCI) | Episode-based (acute inpatient medical condition) | 20 | xlsx | |
| Acute Kidney Injury Requiring New Inpatient Dialysis | Episode-based (procedural) | 10 | xlsx | |
| Elective Primary Hip Arthroplasty | Episode-based (procedural) | 10 | xlsx | |
| Femoral or Inguinal Hernia Repair | Episode-based (procedural) | 10 | xlsx | |
| Hemodialysis Access Creation | Episode-based (procedural) | 10 | xlsx | |
| Inpatient Chronic Obstructive Pulmonary Disease (COPD) Exacerbation | Episode-based (acute inpatient medical condition) | 20 | xlsx | |
| Lower Gastrointestinal Hemorrhage (at group level only) | Episode-based (acute inpatient medical condition) | 20 | xlsx | |
| Lumbar Spine Fusion for Degenerative Disease, 1-3 Levels | Episode-based (procedural) | 10 | xlsx | |
| Lumpectomy, Partial Mastectomy, Simple Mastectomy | Episode-based (procedural) | 10 | xlsx | |
| Non-Emergent Coronary Artery Bypass Graft (CABG) | Episode-based (procedural) | 10 | xlsx | |
| Renal or Ureteral Stone Surgical Treatment | Episode-based (procedural) | 10 | xlsx | |
| Asthma/Chronic Obstructive Pulmonary Disease (COPD) | Episode-based (chronic condition) | 20 | xlsx | |
| Colon and Rectal Resection | Episode-based (procedural) | 20 | xlsx | |
| Diabetes | Episode-based (chronic condition) | 20 | xlsx | |
| Melanoma Resection | Episode-based (procedural) | 10 | xlsx | |
| Sepsis | Episode-based (acute inpatient medical condition) | 20 | xlsx | |
| Depression | Episode-based (chronic condition) | 20 | xlsx | |
| Emergency Medicine | Episode-based (care setting) | 20 | xlsx | |
| Heart Failure | Episode-based (chronic condition) | 20 | xlsx | |
| Low Back Pain | Episode-based (chronic condition) | 20 | xlsx | |
| Psychoses and Related Conditions | Episode-based (acute inpatient medical) | 20 | xlsx |
Licenses are available.