[{"_1":2,"_252":-5,"_253":-5},"loaderData",{"_3":4,"_13":14},"root",{"_5":6,"_7":8,"_9":10,"_11":12},"shouldUseQualtrics",true,"cssHref","https://qpp.cms.gov/styles/main.min.css","utagSyncSrc","https://tealium-tags.cms.gov/cms-qpp/prod/utag.sync.js","utagAsyncSrc","https://tealium-tags.cms.gov/cms-qpp/prod/utag.js","routes/mips",{"_15":16,"_244":245,"_248":249,"_250":251},"data",{"_17":18,"_48":49,"_85":86,"_115":116,"_171":172,"_207":208},"Cost: Traditional MIPS Requirements Intro",[19,30,38,43],{"_20":21,"_22":23,"_24":-5,"_25":23,"_26":27,"_28":29},"id","81bb61bd-f953-4604-8868-aec3e9e646f4","updated",false,"colorScheme","sectionTag","content","

Overview

This page provides an overview of cost requirements for traditional MIPS. For information regarding the cost requirements for the MIPS Value Pathways (MVPs) reporting option, visit Explore MVPs. Clinicians reporting via the Alternative Payment Model (APM) Performance Pathway (APP) aren't scored on cost measures. Learn more about the APP.

Select Performance Year

","type","paragraph--rich_text",{"_20":31,"_32":33,"_34":35,"_26":36,"_28":37},"add56bfb-cbb4-40f6-94a8-d69b3abb453b","name","PY","alias","/taxonomy/glossary-term/add56bfb-cbb4-40f6-94a8-d69b3abb453b","

Performance Year

\n\n

The period in which program participants must collect QPP data. They report the data they’ve collected in the first few months of the following year.

\n\n

The MIPS Performance Year begins on January 1 and ends on December 31 each year.

\nLearn more about Performance Year deadlines

\n","taxonomy_term--qpp_glossary",{"_20":39,"_32":40,"_34":41,"_26":42,"_28":37},"98e6bc0f-8732-45ef-a1ab-d0ea8280a43e","hospital VBP","/taxonomy/glossary-term/98e6bc0f-8732-45ef-a1ab-d0ea8280a43e","

Hospital Value-Based Purchasing

\n\n

A program that rewards acute care hospitals with incentive payments for the quality of care they give to people with Medicare. This program adjusts payments to hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of care they deliver.

\n",{"_20":44,"_32":45,"_34":46,"_26":47,"_28":37},"36722ade-8c2c-4548-8ae9-3171a61b81b9","performance period","/taxonomy/glossary-term/36722ade-8c2c-4548-8ae9-3171a61b81b9","

The time period for which CMS assesses a clinician, group, virtual group, or APM Entity’s performance in MIPS. Each MIPS performance category has its own defined performance period.

\n","Cost: Traditional MIPS Requirements PY 2021",[50,57,60,69,72,75,30,38,43],{"_20":51,"_52":53,"_22":23,"_54":55,"_28":56},"4e30bb56-ca7e-45b6-9fbf-54a3546b0114","title","2021 Cost Requirements","htmlId","2021-cost-requirements","paragraph--heading",{"_20":58,"_22":6,"_24":-5,"_25":23,"_26":59,"_28":29},"591ada6e-e978-4fd4-952b-78dcc1354e7e","

0% OF FINAL SCORE

\n\n

*CLINICIANS DON’T NEED TO TAKE ANY ACTION AS A RESULT OF THIS UPDATE.

\n\n

Reweighting Cost for Performance Year 2021

\n\n

We’re reweighting the cost performance category from 20% to 0% for the 2021 performance year. The 20% cost performance category weight will be redistributed to another performance category or categories.

\n\n

Based on our analysis of the 2021 performance year data, we don’t believe we can reliably calculate scores for some of the cost measures that would adequately capture and reflect the performance of MIPS eligible clinicians.

\n\n

We’ll provide patient-level reports on the cost measures for which clinicians, groups and virtual groups met the case minimum, but we won’t include measure-level scoring information in performance feedback. Patient-level reports will be available as part of the final performance feedback in August 2022.

\n\n

Cost reweighting applies to all MIPS eligible clinicians, whether participating as an individual, group or virtual group. Cost is already weighted at 0% for clinicians in a MIPS Alternative Payment Model (APM) who are reporting the APM Performance Pathway (APP), and for APM Entities reporting traditional MIPS.

\n\n

Please refer to the Appendix in the 2021 Cost Quick Start Guide to review the QPP listserv announcing this decision.

\n",{"_20":61,"_52":62,"_63":64,"_65":66,"_26":67,"_28":68},"36f5b2bb-5564-4742-bf55-93b9a05b0892","View Cost Measures","actionUrl","https://qpp.cms.gov/mips/explore-measures?tab=costMeasures&py=2021#measures","actionText","Explore the 2021 cost measures.","","paragraph--cta",{"_20":70,"_22":23,"_24":-5,"_25":23,"_26":71,"_28":29},"fb1f47f2-ee10-4446-a1d7-2c8178cf1818","

Additional Resources

\n",{"_20":73,"_22":23,"_24":-5,"_25":23,"_26":74,"_28":29},"8a945a61-dcf4-4e42-abd7-e135baa737a5","

\n 2021 Cost Quick Start Guide (pdf)\n 2021 MIPS Cost User Guide (zip)\n

",{"_20":76,"_77":78,"_79":-5,"_32":80,"_81":6,"_82":83,"_28":84},"1fc5a085-5764-47ad-9d1b-c8e5fd7ea2c7","fileType","zip","resourceSize","Virtual Group Toolkit","withIcon","url","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1638/2022%20Virtual%20Group%20Toolkit.zip","paragraph--resource_component","Cost: Traditional MIPS Requirements PY 2022",[87,91,94,98,101,104,106,111,30,38,43],{"_20":88,"_52":89,"_22":23,"_54":90,"_28":56},"b7f00d16-ad5d-4566-9c2d-fd9e35e77670","2022 Cost Performance Category: Traditional MIPS Requirements","2022-cost-performance-category-traditional-mips-requirements",{"_20":92,"_22":6,"_24":-5,"_25":23,"_26":93,"_28":29},"941bbf05-9bc6-4701-8260-f644116bf173","

30% OF FINAL SCORE

\n\n

This percentage can change due to Exception Applications, Alternative Payment Model (APM) Entity participation, or if you don’t meet the established case minimum for at least one cost measure. If you don't meet the established case minimum for any of the 25 measures to be scored, the cost performance category will receive zero weight when calculating your final score and the 30% will be distributed to another performance category (or categories).

\n\n

This page reviews cost requirements for traditional MIPS. Clinicians reporting via the APM Performance Pathway (APP) aren't scored on cost measures. Learn more about the APP.

\n\n

For performance year 2022, we use cost measures that assess:

\n\n

The overall cost of care provided to Medicare patients, with a focus on the primary care they received.
The cost of services related to a hospital stay provided to Medicare patients.
Costs for items and services provided during 23 procedural and condition-based episodes of care for Medicare patients. There are 25 cost measures available for performance year 2022.

\n\n

There are 5 new measures for performance year 2022:

\n\n

2 procedural measures: Melanoma Resection; Colon and Rectal Resection
1 acute inpatient measure: Sepsis.
2 chronic condition measures: Diabetes; Asthma/Chronic Obstructive Pulmonary Disease.

\n\n

NOTE: The cost performance category is weighted to 0% for MIPS APM Entities that choose to report to traditional MIPS.

\n\n

What Cost Data Should I Submit?

\n\n

We use Medicare Part A and B claims data to calculate cost measure performance, which means clinicians and groups don’t have to submit any data for this performance category.

\n",{"_20":95,"_52":62,"_63":96,"_65":97,"_26":67,"_28":68},"b18c8254-8a18-4268-abb6-f2c497492bf8","https://qpp.cms.gov/mips/explore-measures?tab=costMeasures&py=2022#measures","Explore the 2022 cost measures",{"_20":99,"_22":23,"_24":-5,"_25":23,"_26":100,"_28":29},"7934d31e-749b-4e42-9591-6cf78aa57365","

How Are Measures Scored?

\n\n

You'll be evaluated and scored on each cost measure for which you meet or exceed the established case minimum.

\n\n

We determine measure achievement points by comparing performance on a measure to a performance period benchmark. We calculate cost measure benchmarks using performance data from the performance period, rather than historical data.

\n\n

You must meet the established case minimum for and be scored on at least one measure to receive a cost performance category score.

\n",{"_20":102,"_22":6,"_24":-5,"_25":23,"_26":103,"_28":29},"a3aee655-8065-4dd3-9044-c3fc4bf36cb1","

When Will Facility-Based Scoring Apply?

\n\n

Facility-based scoring isn't available for the 2022 performance year. Learn more.

\n",{"_20":105,"_22":23,"_24":-5,"_25":23,"_26":71,"_28":29},"2a2755bc-9414-4445-bca2-5c6327917ccc",{"_20":107,"_77":108,"_79":-5,"_32":109,"_81":23,"_82":110,"_28":84},"156d47d8-16f1-492b-92cd-9c60454d35df","pdf","2022 Cost User Guide","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1855/2022%20MIPS%20Cost%20User%20Guide.pdf",{"_20":112,"_77":108,"_79":-5,"_32":113,"_81":23,"_82":114,"_28":84},"0ddf522a-d99b-47b5-bca7-28d2686caf79","2022 Cost Quick Start Guide","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1712/2022%20Cost%20Quick%20Start%20Guide.pdf","Cost: Traditional MIPS Requirements PY 2023",[117,120,123,126,130,133,136,139,158,30,38,43],{"_20":118,"_22":23,"_24":-5,"_25":23,"_26":119,"_28":29},"61d8d46a-529f-4e69-a60b-78ba37b10018","

Cost: 2023 Performance Year Requirements

Score Weight

30% OF FINAL SCORE

This percentage can change due to:

Exception applications,
Alternative Payment Model (APM) Entity participation, or
If you don’t meet the established case minimum for at least one cost measure.

If you don't meet the established case minimum for any of the available cost measures, the cost performance category will receive zero weight when calculating your final score and the 30% will be distributed to another performance category (or categories).

There are 24 cost measures available for the 2023 performance period, including:

Episode-based cost measures based on a range of procedures, acute inpatient medical conditions, and chronic conditions, and
Population-based cost measures focused more broadly on primary and inpatient care.

",{"_20":121,"_22":6,"_24":-5,"_25":23,"_26":122,"_28":29},"4f523270-f800-407d-8d7d-630114cf179c","

As announced through the QPP listserv on May 28, 2024, the Simple Pneumonia with Hospitalization episode-based cost measure will be excluded from the calculation of MIPS eligible clinicians’ scores under the 2023 cost performance category. For more information about the exclusion of the Simple Pneumonia with Hospitalization measure, please see the 2023 MIPS Cost Measure Exclusion Fact Sheet (PDF, 190KB).

NOTE: The cost performance category is weighted to 0% for MIPS APM Entities that choose to report traditional MIPS.

Data Submission

We use Medicare administrative claims data to calculate cost measure performance, which means clinicians and groups don’t have to submit any data for this performance category.

",{"_20":124,"_22":23,"_24":-5,"_25":23,"_26":125,"_28":29},"99e89e5e-6bca-415e-a8c1-7b24900b8ff5","

Cost Measures

\n\n

Scoring Cost Measures

\n\n

You must meet the established case minimum for and be scored on at least one measure to receive a cost performance category score.

\n",{"_20":127,"_52":62,"_63":128,"_65":129,"_26":67,"_28":68},"3c6c5129-4e9b-4679-a248-2334d6ecc76f","https://qpp.cms.gov/mips/explore-measures?tab=costMeasures&py=2023","Explore the 2023 cost measures",{"_20":131,"_22":23,"_24":-5,"_25":23,"_26":132,"_28":29},"b6d37e75-c1c9-425c-a6b4-c866eb05db60","

\nCost Improvement Scoring

\n",{"_20":134,"_22":6,"_24":-5,"_25":23,"_26":135,"_28":29},"aa85cb2d-b9e7-4145-9dbf-446f25fc72f9","

Starting with the calendar year 2022 performance period/2024 MIPS payment year, we’ve established a maximum cost improvement score of 1 percentage point out of 100 percentage points available for the cost performance category.

\n\n

NOTE: All MIPS eligible clinicians will receive a cost improvement score of zero percentage points for the 2022 performance period because we didn’t calculate cost measure scores for the 2021 performance period.

\n",{"_20":137,"_22":23,"_24":-5,"_25":23,"_26":138,"_28":29},"39f6cbf9-730a-4f79-b856-b15fc2fc9557","

Facility-based Scoring

\n\n

Facility-based scoring may be applied to facility-based clinicians, groups and virtual groups.

\n\n

Facility-based scoring will be used for your quality and cost performance category scores when all the following conditions are met:

\n\n

You’re identified as facility-based.
You’re attributed to a facility with a fiscal year 2024 Hospital Value-Based Purchasing (VBP) Program score.
The facility-based scoring methodology using your Hospital VBP Program score results in a higher final score than your final score calculated without the application of facility-based measurement.

\n\n

Additional Resources

\n",{"_20":140,"_141":142,"_28":157},"ea728d6c-0a2b-435e-86ae-e33599f304e7","fieldCardDataForUI",[143,152],{"_144":145,"_146":147,"_148":149,"_52":149,"_150":67,"_26":151},"resourceId","f2175d1f-aabe-4783-8574-54619517a2ac","resourceUrl","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2378/2023%20MIPS%20Cost%20User%20Guide.pdf","resourceUrlTitle","2023 MIPS Cost User Guide","performanceYear","

Foundational knowledge on the cost performance category, reporting, scoring, receiving feedback, and facility-based measurement and scoring.

",{"_144":153,"_146":154,"_148":155,"_52":155,"_150":67,"_26":156},"203a8078-e374-47d4-a509-91809086deda","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2218/2023%20Cost%20Quick%20Start%20Guide.pdf","2023 Cost Quick Start Guide","

Information on the measures available and how they’re attributed, how score is calculated, and the type of feedback that can be expected.

","paragraph--card_grid_two_col",{"_20":159,"_141":160,"_28":157},"08221777-eff8-42d0-b055-ef9e52e531af",[161,166],{"_144":162,"_146":163,"_148":164,"_52":164,"_150":67,"_26":165},"3af7153d-db8f-48e4-9558-ef1d61e12907","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2294/MIPS%20Cost%20Performance%20Category%20Fact%20Sheet.pdf","Cost Performance Category Fact Sheet","

An overview of the cost performance category, how score is calculated, related key terms, and available cost measures.

",{"_144":167,"_146":168,"_148":169,"_52":169,"_150":67,"_26":170},"9c1232b5-77ca-4ccf-be1b-1fb9b654070e","https://www.cms.gov/medicare/quality/value-based-programs/cost-measures","QPP Cost Measure Information Webpage","

CMS collaborates with clinicians and other interested parties to develop cost measures for potential implementation. This webpage contains information about this process, including how to participate.

","Cost: Traditional MIPS Requirements PY 2024",[173,176,178,182,184,187,190,193,202,30,38,43],{"_20":174,"_22":23,"_24":-5,"_25":23,"_26":175,"_28":29},"8956988b-1ff0-46de-8ae3-afb8d096ec36","

Cost: 2024 Performance Year Requirements

\n\n

Score Weight

\n\n

30% OF FINAL SCORE

\n\n

This percentage can change due to:

\n\n

Exception applications,
Alternative Payment Model (APM) Entity participation, or
If you don’t meet the established case minimum for at least one cost measure.

\n\n

There are 29 cost measures available for the 2024 performance period, including:

\n\n

Episode-based cost measures based on a range of procedures, acute inpatient medical conditions, and chronic conditions, and
Population-based cost measures focused more broadly on primary and inpatient care.

\n\n

NOTE: The cost performance category is weighted to 0% for MIPS APM Entities that choose to report traditional MIPS.

\n\n

Data Submission

\n\n

We use Medicare administrative claims data to calculate cost measure performance, which means clinicians and groups don’t have to submit any data for this performance category.

\n",{"_20":177,"_22":23,"_24":-5,"_25":23,"_26":125,"_28":29},"f5261a21-2166-417a-9a66-44ca7c4c86f7",{"_20":179,"_52":62,"_63":180,"_65":181,"_26":67,"_28":68},"ae53a5ef-fc24-446f-8a31-f26fbf4701f2","https://qpp.cms.gov/mips/explore-measures?tab=costMeasures&py=2024","Explore the 2024 cost measures.",{"_20":183,"_22":23,"_24":-5,"_25":23,"_26":132,"_28":29},"f806e384-aac5-4833-8d0d-240bbb8d9111",{"_20":185,"_22":6,"_24":-5,"_25":23,"_26":186,"_28":29},"a4ec893d-cf24-4d8a-903c-f2dc211677c5","

The maximum cost improvement score of 1 percentage point out of 100 percentage points will be available for the cost performance category beginning with the 2023 performance period/2025 MIPS payment year.

\n\n

NOTE: All MIPS eligible clinicians received a cost improvement score of zero percentage points for the 2022 performance period because we didn’t calculate cost measure scores for the 2021 performance period.

\n",{"_20":188,"_22":23,"_24":-5,"_25":23,"_26":189,"_28":29},"3353aac3-25fb-429d-8ae8-4481fbe7064f","

Facility-based Scoring

\n\n

Facility-based scoring may be applied to facility-based clinicians, groups and virtual groups.
\n
\nFacility-based scoring will be used for your quality and cost performance category scores when all the following conditions are met:

\n\n

You’re identified as facility-based.
You’re attributed to a facility with a fiscal year 2025 Hospital Value-Based Purchasing (VBP) Program score.
The facility-based scoring methodology using your Hospital VBP Program score results in a higher final score than your final score calculated without the application of facility-based measurement.

\n",{"_20":191,"_22":23,"_24":-5,"_25":23,"_26":192,"_28":29},"c1a59aed-653b-4b14-b7cd-c869ccb883c1","

Additional Resources

\n",{"_20":194,"_141":195,"_28":157},"0c42a5af-882d-4ada-9944-e4975da884be",[196,200],{"_144":197,"_146":198,"_148":199,"_52":199,"_150":67,"_26":156},"a1962f99-ebc3-4851-80fc-245016697f31","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2658/2024CostQuickStartGuide.pdf","2024 Cost Quick Start Guide",{"_144":201,"_146":163,"_148":164,"_52":164,"_150":67,"_26":165},"ca47d64a-8e82-4f1d-b6c3-bf7feb89cedb",{"_20":203,"_141":204,"_28":157},"0a66a64c-8d6d-40e3-8437-0e80a2205e57",[205],{"_144":206,"_146":168,"_148":169,"_52":169,"_150":67,"_26":170},"e73ec4a0-2be7-49b2-9c2e-a12484b88423","Cost: Traditional MIPS Requirements PY 2025",[209,212,215,218,222,225,228,231,234,30,38,43],{"_20":210,"_22":23,"_24":-5,"_25":23,"_26":211,"_28":29},"44d13d9c-2b5c-4f20-9360-27dfefb29a62","

Cost: 2025 Performance Year Requirements

Score Weight

30% OF FINAL SCORE

This percentage can change due to:

Exception applications

If you don't meet the established case minimum for any of the available cost measures, you won’t be scored on the cost performance category and the 30% weight will be distributed to another performance category (or categories).

Note: APM Entities reporting traditional MIPS aren’t evaluated on cost.

The MIPS cost performance category assesses the costs of care provided to Medicare patients.

Like the quality performance category, cost performance is tied to individual measures.

There are 35 cost measures available for the 2025 performance period, including:

Episode-based cost measures based on a range of procedures, acute inpatient medical conditions, and chronic conditions, and
Population-based cost measures focused more broadly on primary and inpatient care.

Data Submission

We use Medicare administrative claims data to calculate cost measure performance, which means clinicians and groups don’t have to submit any data for this performance category.

",{"_20":213,"_22":23,"_24":-5,"_25":23,"_26":214,"_28":29},"525b852e-aff8-4f05-bfc1-a901aacebf24","

Cost Measures

Scoring Cost Measures

You must meet the established case minimum for and be scored on at least one measure to receive a cost performance category score.

",{"_20":216,"_22":6,"_24":-5,"_25":23,"_26":217,"_28":29},"a3a0daaf-d87f-49e0-a812-5be953d2f11e","

We updated the cost measure scoring methodology to more appropriately incentivize or penalize clinicians with costs above or below national average spending. Review the Additional Resources for more information.

",{"_20":219,"_52":62,"_63":220,"_65":221,"_26":67,"_28":68},"f20b31d9-2c72-4def-a650-ea8fc1c0057d","https://qpp.cms.gov/mips/explore-measures?tab=costMeasures&py=2025","Explore the 2025 cost measures.",{"_20":223,"_22":23,"_24":-5,"_25":23,"_26":224,"_28":29},"0af95896-d4f3-473c-b2a1-00dc24880fc3","

Cost Improvement Scoring

",{"_20":226,"_22":23,"_24":-5,"_25":23,"_26":227,"_28":29},"110b6733-3ba0-45f9-91a3-434b3d6d853f","

A maximum cost improvement score of 1 percentage point out of 100 percentage points is available for the cost performance category.

",{"_20":229,"_22":23,"_24":-5,"_25":23,"_26":230,"_28":29},"6ce213b4-92f7-43b4-bb26-622ebdd593bb","

Facility-based Scoring

Facility-based scoring may be applied to facility-based clinicians, groups and virtual groups.

Facility-based scoring will be used for your quality and cost performance category scores when all the following conditions are met:

You’re identified as facility-based.
You’re attributed to a facility with a fiscal year 2026 Hospital Value-Based Purchasing (VBP) Program score.
The facility-based scoring methodology using your Hospital VBP Program score results in a higher final score than your final score calculated without the application of facility-based measurement.

",{"_20":232,"_22":23,"_24":-5,"_25":23,"_26":233,"_28":29},"fc4cd946-b90c-44c3-82c9-03e714a4ae0b","

Additional Resources

",{"_20":235,"_141":236,"_28":157},"c578bdd2-d66d-45d7-9b67-f54ddb21f173",[237,242],{"_144":238,"_146":239,"_148":240,"_52":240,"_150":67,"_26":241},"58705695-c2ce-45b0-b3a5-9e179984425f","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/3057/2025-QPP-Policies-Final-Rule-Fact-Sheet.pdf","2025 QPP Policies Final Rule Fact Sheet","

Learn more about the changes finalized for cost measure scoring in the Calendar Year (CY) CY 2025 Medicare Physician Fee Schedule Final Rule.

",{"_144":243,"_146":168,"_148":169,"_52":169,"_150":67,"_26":170},"b42d224c-78a6-4c68-bab4-5b6bcc88610e","metatags",{"_246":247},"metaTitle","Cost Performance Category: Traditional MIPS Requirements","pageTitle","Cost: Traditional MIPS Requirements","path","/mips/cost","actionData","errors"]