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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.

Cost: 2023 Performance Year Requirements

Score Weight

30% OF FINAL SCORE

This percentage can change due to:

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.
Updated

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.

Cost Measures

Scoring Cost Measures

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.


Cost Improvement Scoring

Updated

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. 

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. 

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 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.

Additional Resources

2023 MIPS Cost User Guide

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

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.

Cost Performance Category Fact Sheet

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