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Cost Category

Cost Category

The cost performance category evaluates relative cost efficiency based on performance. Cost measures are risk-adjusted, accounting for variations in clinician costs due to patient age, comorbidities, and other factors. All measures use attribution methodologies based on service and diagnosis information from administrative claims data to identify care provided by a specific clinician or group.

MIPS Cost Performance Category Fact Sheet

2024-mips-summary-cost-measures.pdf
494.1 KB

Cost Attribution

Open the measure specifications for more information on each measure:

Medicare Spending Per Beneficiary.pdf
1.4 MB
Total Per Capita Cost TPCCMeasure.pdf
2.4 MB

Procedural Measures

Attributes episodes to each MIPS-eligible clinician who renders a trigger service as identified by HCPCS/CPT procedure codes.

  • Parts A & B

  • Case minimum: 10 episodes, except Colon & Rectal Resection measure with case minimum of 20 episodes

Open the measure specifications for more information on each measure:

Acute Kidney Injury Requiring New Inpatient Dialysis Measure.pdf
694.1 KB
Colon and Rectal Resection Measure.pdf
1.4 MB
Elective Outpatient Percutaneous Coronary Intervention PCI Measure.pdf
1.3 MB
Elective Primary Hip Arthroplasty Measure.pdf
1.3 MB
Femoral or Inguinal Hernia Repair Measure.pdf
1.4 MB
Hemodialysis Access Creation Measure.pdf
1.3 MB
Knee Arthroplasty Measure.pdf
1.4 MB
Lumbar Spine Fusion for Degenerative Disease 13 Levels Measure.pdf
1.4 MB
Lumpectomy Partial Mastectomy Simple Mastectomy Measure.pdf
1.4 MB
Melanoma Resection Measure.pdf
1.4 MB
Non-Emergent Coronary Artery Bypass Graft CABG Measure.pdf
1.4 MB
Renal or Ureteral Stone Surgical Treatment Measure.pdf
1.4 MB
Revascularization for Lower Extremity Chronic Critical Limb Ischemia Measure.pdf
1.4 MB
Routine Cataract Removal with Intraocular Lens (IOL) Implantation Measure.pdf
760.6 KB
ScreeningSurveillance Colonoscopy Measure.pdf
1.4 MB

Inpatient Measures

Assesses cost of care clinically related to specific acute inpatient medical conditions provided during an episode’s timeframe.

  • Medicare Parts A & B

  • Case minimum: 20 episodes

Open the measure specifications for more information on each measure:

Inpatient Chronic Obstructive Pulmonary Disease COPD Exacerbation Measure.pdf
1.8 MB
Lower Gastrointestinal Hemorrhage Measure.pdf
1.8 MB
Psychoses and Related Conditions Measure.pdf
3.3 MB
Sepsis Measure.pdf
1.8 MB
STElevation Myocardial Infarction (STEMI) with Percutaneous Coronary Intervention PCI Measure.pdf
1.8 MB
Intracranial Hemorrhage or Cerebral Infarction Measure.pdf
1.8 MB

Chronic Condition Measures

Assesses cost of care clinically related to the care and management of patients’ specific chronic conditions provided during a total attribution window.

  • Medicare Parts A, B & D

  • Case minimum: 20 episodes

Open the measure specifications for more information on each measure:

Depression Measure.pdf
4.6 MB
Diabetes.pdf
4.4 MB
AsthmaChronic Obstructive Pulmonary Disease COPD Measure.pdf
3.2 MB
Low Back Pain Measure.pdf
4.2 MB
Heart Failure Measure.pdf
4.4 MB

Care Settings

Open the measure specifications for more information on the measure:

Emergency Medicine Measure.pdf
3.2 MB
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