2020 MIPS

Cost Performance Category

  • 10 new episode-based measures added which revise the Medicare Spending per Beneficiary Clinician and Total Per Capita Cost measures.
  • Total Category Score is averaged from the score of all applicable measures.
  • Measure performance is tracked over a full calendar year.
  • Clinicians can preview 2018-2020 performance on a quarterly basis via MIPSpro Enterprise or through REVlytix packages.
15 %
of MIPS Composite Performance Score


Key Changes From 2019 Cost Reporting

  • There has been no change from payment year 2019. Cost has a 15% weight and Quality has a 45% weight in the overall MIPS performance score.
  • 10 new episode-based measures are now part of the Cost performance category score.

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 which decile range you or your group’s performance falls in.

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

Revlytix is the next big thing in Cost tracking, optimization and revenue-generating insights.

Key Benefits

See total Medicare spend, even outside your network.

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

Better impact your MIPS Cost score.

Contact us today to learn how REVlytix can help you achieve your revenue goals and improve care.


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