U.S. flag

An official website of the United States government

Search (beta)
Help

Cost: Traditional MIPS Requirements

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

Performance Year

Select your performance year.

2022 Cost Performance Category: Traditional MIPS Requirements

Updated

30% OF FINAL SCORE

This percentage can change due to Exception ApplicationsAlternative 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).

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.

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

  • 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.

There are 5 new measures for performance year 2022:

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

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

What Cost Data Should I Submit?

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.

How Are Measures Scored?

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

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.

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

Updated

When Will Facility-Based Scoring Apply?

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

Additional Resources