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 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 for the 2024 reporting year.