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Explore Measures

How to Use This Tool

This tool has been created to help you get familiar with the different measures you can submit and prepare for the year. It's for planning purposes only and will not submit anything to CMS. To get the most out of the tool, follow the steps below:

  1. Explore (Search, browse, or filter) available measures
  2. Add measures you're interested in to your list
  3. Download your list of interested measures for reference

Performance Year

Select your performance year to view across all tabs.

2019 Cost Measures

15% of final score

This percentage can change if the measures' minimum case volumes are not met. If there are not enough attributed beneficiaries for any of the 10 measures to be scored, the Cost performance category percentage will be added to the Quality performance category. 

There is no data submission requirement for the Cost performance category. Cost measures are evaluated automatically through administrative claims data.

Read more about Cost requirements

10 Cost Measures
  • Elective Outpatient Percutaneous Coronary Intervention (PCI)

    The Elective Outpatient PCI cost measure is meant to apply to clinicians who perform Elective Outpatient PCIs for Medicare beneficiaries during the performance period. This surgical procedure is meant to place a coronary artery stent for heart disease in a non-emergent, outpatient setting. The measure evaluates a clinician's risk-adjusted cost for the episode group by averaging it across all episodes attributed to the clinician. The cost of each episode is the sum of the cost to Medicare for services performed by the attributed clinician and other health care providers over the length of the episode, or "episode window." The cost measure is calculated by determining the risk-adjusted episode cost, averaged across all of a clinician's episodes during the performance period.

    Submission Methods

    • Administrative Claims

    Measure ID

    COST_EOPCI_1

  • Intracranial Hemorrhage or Cerebral Infarction

    The Intracranial Hemorrhage or Cerebral Infarction cost measure is meant to apply to clinicians who manage the inpatient care of Medicare beneficiaries hospitalized for an intracranial hemorrhage or cerebral infarction during the performance period. This cost measure excludes those patients whose initial hospitalization was due to a subarachnoid hemorrhage or a cerebral infarction which received thrombolytic therapy. The measure evaluates a clinician’s risk-adjusted cost for the episode group by averaging it across all episodes attributed to the clinician. The cost of each episode is the sum of the cost to Medicare for services performed by the attributed clinician and other health care providers over the length of the episode, or “episode window.” The cost measure is calculated by determining the risk-adjusted episode cost, averaged across all of a clinician’s episodes during the performance period.

    Submission Methods

    • Administrative Claims

    Measure ID

    COST_IHCI_1

  • Knee Arthroplasty

    The Knee Arthroplasty cost measure is meant to apply to clinicians who perform elective total and partial knee arthroplasties during the performance period for Medicare beneficiaries. This surgical procedure is meant to replace a patient’s own poorly functional knee with an artificial one, thereby reducing pain and increasing mobility. The measure evaluates a clinician’s risk-adjusted cost for the episode group by averaging it across all episodes attributed to the clinician. The cost of each episode is the sum of the cost to Medicare for services performed by the attributed clinician and other health care providers over the length of the episode, or “episode window.” The cost measure is calculated by determining the risk-adjusted episode cost, averaged across all of a clinician’s episodes during the performance period.

    Submission Methods

    • Administrative Claims

    Measure ID

    COST_KA_1

  • Medicare Spending Per Beneficiary (MSPB)

    The Medicare Spending Per Beneficiary (MSPB) measure evaluates solo practitioners and groups on their spending efficiency and is risk-adjusted to account for patients' risk profiles. Solo practitioners and groups are identified by their National Provider Identification (NPI) and Taxpayer Identification Number (TIN) combination. Specifically, the MSPB measure assesses the average spend for Medicare services performed by providers/groups per episode of care. Each episode comprises the period immediately prior to, during, and following a patient's hospital stay.

    Submission Methods

    • Administrative Claims

    Measure ID

    MSPB_1

  • Revascularization for Lower Extremity Chronic Critical Limb Ischemia

    The Revascularization for Lower Extremity Chronic Critical Limb Ischemia cost measure is meant to apply to clinicians who perform elective revascularization for lower extremity chronic critical limb ischemia for Medicare beneficiaries during the performance period. This surgical procedure is meant to alleviate symptoms of pain and difficulty walking associated with chronic limb ischemia and excludes those patients who require emergent revascularization for acute limb ischemia. The measure evaluates a clinician’s risk-adjusted cost for the episode group by averaging it across all episodes attributed to the clinician. The cost of each episode is the sum of the cost to Medicare for services performed by the attributed clinician and other health care providers over the length of the episode, or “episode window.” The cost measure is calculated by determining the risk-adjusted episode cost, averaged across all of a clinician’s episodes during the performance period.

    Submission Methods

    • Administrative Claims

    Measure ID

    COST_CCLI_1

  • Routine Cataract Removal with Intraocular Lens (IOL) Implantation

    The Routine Cataract Removal with IOL Implantation cost measure is meant to apply to clinicians who perform Routine Cataract Removal with IOL Implantation procedures for Medicare beneficiaries during the performance period. The measure evaluates a clinician’s risk-adjusted cost for the episode group by averaging it across all episodes attributed to the clinician. The cost of each episode is the sum of the cost to Medicare for services performed by the attributed clinician and other health care providers over the length of the episode, or “episode window.” The cost measure is calculated by determining the risk-adjusted episode cost, averaged across all of a clinician’s episodes during the performance period.

    Submission Methods

    • Administrative Claims

    Measure ID

    COST_IOL_1

  • Screening/Surveillance Colonoscopy

    The Screening/Surveillance Colonoscopy cost measure is meant to apply to clinicians who perform screening/surveillance colonoscopy procedures for Medicare beneficiaries during the performance period. Screening and surveillance colonoscopies are preventative care procedures that are meant to detect the presence of colorectal cancer (CRC) among patients who are at average risk or high risk of CRC, respectively. The measure evaluates a clinician’s risk-adjusted cost for the episode group by averaging it across all episodes attributed to the clinician. The cost of each episode is the sum of the cost to Medicare for services performed by the attributed clinician and other health care providers over the length of the episode, or “episode window.” The cost measure is calculated by determining the risk-adjusted episode cost, averaged across all of a clinician’s episodes during the performance period.

    Submission Methods

    • Administrative Claims

    Measure ID

    COST_SSC_1

  • Simple Pneumonia with Hospitalization

    The Simple Pneumonia with Hospitalization cost measure is meant to apply to clinicians who manage the inpatient care of Medicare beneficiaries hospitalized with simple pneumonia during the performance period. This acute inpatient medical condition episode group is meant to capture patients who are hospitalized for pneumonia without severe complicating factors. The measure evaluates a clinician’s risk-adjusted cost for the episode group by averaging it across all episodes attributed to the clinician. The cost of each episode is the sum of the cost to Medicare for services performed by the attributed clinician and other health care providers over the length of the episode, or “episode window.” The cost measure is calculated by determining the risk-adjusted episode cost, averaged across all of a clinician’s episodes during the performance period.

    Submission Methods

    • Administrative Claims

    Measure ID

    COST_SPH_1

  • ST-Elevation Myocardial Infarction (STEMI) with Percutaneous Coronary Intervention (PCI)

    The STEMI with PCI cost measure is meant to apply to clinicians who manage the inpatient care of Medicare beneficiaries hospitalized during the performance period for a STEMI requiring PCI. This acute medical condition captures the care of those patients who present with STEMI indicating complete blockage of a coronary artery who emergently receive PCI as treatment. The measure evaluates a clinician’s risk-adjusted cost for the episode group by averaging it across all episodes attributed to the clinician. The cost of each episode is the sum of the cost to Medicare for services performed by the attributed clinician and other health care providers over the length of the episode, or “episode window.” The cost measure is calculated by determining the risk-adjusted episode cost, averaged across all of a clinician’s episodes during the performance period.

    Submission Methods

    • Administrative Claims

    Measure ID

    COST_STEMI_1

  • Total Per Capita Costs (TPCC)

    The Total Per Capita Costs (TPCC) measure is a payment-standardized, annualized, risk-adjusted, and specialty-adjusted measure that evaluates the overall efficiency of care provided to beneficiaries attributed to solo practitioners and groups, as identified by their Medicare Taxpayer Identification Number (TIN).

    Submission Methods

    • Administrative Claims

    Measure ID

    TPCC_1