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Explore Measures & Activities

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.

2020 Cost Measures

15% of final score

This percentage can change if you do not meet minimum case volumes for at least one cost measure. If there are not enough attributed cases for any of the 20 measures to be scored, the Cost performance category percentage will be added to the Quality performance category.

You do not need to submit data for the Cost performance category. Cost measures are evaluated automatically through administrative claims data.

Read more about Cost requirements

20 Cost Measures
  • Acute Kidney Injury Requiring New Inpatient Dialysis

    Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Acute Kidney Injury Requiring New Inpatient Dialysis episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who receive their first inpatient dialysis service for acute kidney injury during the performance period. The cost measure score is the clinician’s risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician. This procedural measure includes costs of services that are clinically related to the attributed clinician’s role in managing care during each episode from the clinical event that opens, or “triggers,” the episode through 30 days after the trigger.

    Collection Type

    • Administrative claims measures

    Measure ID

    COST_AKID_1

  • Elective Outpatient Percutaneous Coronary Intervention (PCI)

    A clinician’s risk-adjusted cost to Medicare for beneficiaries who undergo elective outpatient PCI surgery to place a coronary stent for heart disease during the performance period. Includes costs of services clinically related to the attributed clinician’s role in managing care from the PCI surgery that triggers the episode through 30 days after the trigger.

    Collection Type

    • Administrative claims measures

    Measure ID

    COST_EOPCI_1

  • Elective Primary Hip Arthroplasty

    Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Elective Primary Hip Arthroplasty episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who receive an elective primary hip arthroplasty during the performance period. The cost measure score is the clinician’s risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician. This procedural measure includes costs of services that are clinically related to the attributed clinician’s role in managing care during each episode from 30 days prior to the clinical event that opens, or “triggers,” the episode through 90 days after the trigger.

    Collection Type

    • Administrative claims measures

    Measure ID

    COST_PHA_1

  • Femoral or Inguinal Hernia Repair

    Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Femoral or Inguinal Hernia Repair episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who undergo surgical procedure to repair a femoral or inguinal hernia during the performance period. The cost measure score is the clinician’s risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician. This procedural measure includes costs of services that are clinically related to the attributed clinician’s role in managing care during each episode from 30 days prior to the clinical event that opens, or “triggers,” the episode through 90 days after the trigger.

    Collection Type

    • Administrative claims measures

    Measure ID

    COST_FIHR_1

  • Hemodialysis Access Creation

    Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Hemodialysis Access Creation episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who undergo a procedure for the creation of graft or fistula access for long-term hemodialysis during the performance period. The cost measure score is the clinician’s risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician. This procedural measure includes costs of services that are clinically related to the attributed clinician’s role in managing care during each episode from 60 days prior to the clinical event that opens, or “triggers,” the episode through 90 days after the trigger.

    Collection Type

    • Administrative claims measures

    Measure ID

    COST_HAC_1

  • Inpatient Chronic Obstructive Pulmonary Disease (COPD) Exacerbation

    Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Inpatient COPD Exacerbation episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who receive inpatient treatment for an acute exacerbation of COPD during the performance period. The cost measure score is the clinician’s risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician. This acute inpatient medical condition measure includes costs of services that are clinically related to the attributed clinician’s role in managing care during each episode from the clinical event that opens, or “triggers,” the episode through 60 days after the trigger.

    Collection Type

    • Administrative claims measures

    Measure ID

    COST_COPDE_1

  • Intracranial Hemorrhage or Cerebral Infarction

    A clinician’s risk-adjusted cost to Medicare for beneficiaries hospitalized for cerebral infarction or intracranial hemorrhage during the performance period. Includes costs of services clinically related to the attributed clinician’s role in managing care from the inpatient hospitalization that triggers the episode through 90 days after the trigger.

    Collection Type

    • Administrative claims measures

    Measure ID

    COST_IHCI_1

  • Knee Arthroplasty

    A clinician’s risk-adjusted cost to Medicare for beneficiaries who undergo an elective knee arthroplasty during the performance period. Includes costs of services clinically related to the attributed clinician’s role in managing care from 30 days prior to the knee arthroplasty that triggers the episode through 90 days after the trigger.

    Collection Type

    • Administrative claims measures

    Measure ID

    COST_KA_1

  • Lower Gastrointestinal Hemorrhage (groups only)

    Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Lower Gastrointestinal Hemorrhage episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who receive inpatient non-surgical treatment for acute bleeding in the lower gastrointestinal tract during the performance period. The cost measure score is the clinician’s risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician. This acute inpatient medical condition measure includes costs of services that are clinically related to the attributed clinician’s role in managing care during each episode from the clinical event that opens, or “triggers,” the episode through 35 days after the trigger.

    Collection Type

    • Administrative claims measures

    Measure ID

    COST_LGH_1

  • Lumbar Spine Fusion for Degenerative Disease, 1-3 Levels

    Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Lumbar Spine Fusion for Degenerative Disease, 1-3 Levels episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who undergo surgery for lumbar spine fusion during the performance period. The cost measure score is the clinician’s risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician. This procedural measure includes costs of services that are clinically related to the attributed clinician’s role in managing care during each episode from 30 days prior to the clinical event that opens, or “triggers,” the episode through 90 days after the trigger.

    Collection Type

    • Administrative claims measures

    Measure ID

    COST_LSFDD_1

  • Lumpectomy Partial Mastectomy, Simple Mastectomy

    Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Lumpectomy, Partial Mastectomy, Simple Mastectomy episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who undergo partial or total mastectomy for breast cancer during the performance period. The cost measure score is the clinician’s risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician. This procedural measure includes costs of services that are clinically related to the attributed clinician’s role in managing care during each episode from 30 days prior to the clinical event that opens, or “triggers,” the episode through 90 days after the trigger.

    Collection Type

    • Administrative claims measures

    Measure ID

    COST_LPMSM_1

  • Medicare Spending Per Beneficiary (MSPB)

    The risk-adjusted cost to Medicare for all Parts A and B services performed for an inpatient beneficiary as a result of a clinician’s care during the period 3 days prior to the patient’s hospital stay through 30 days after discharge.

    Collection Type

    • Administrative claims measures

    Measure ID

    MSPB_1

  • Non-Emergent Coronary Artery Bypass Graft (CABG)

    Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Non-Emergent CABG episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who undergo a CABG procedure during the performance period. The cost measure score is the clinician’s risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician. This procedural measure includes costs of services that are clinically related to the attributed clinician’s role in managing care during each episode from 30 days prior to the clinical event that opens, or “triggers,” the episode through 90 days after the trigger.

    Collection Type

    • Administrative claims measures

    Measure ID

    COST_NECABG_1

  • Renal or Ureteral Stone Surgical Treatment

    Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Renal or Ureteral Stone Surgical Treatment episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who receive surgical treatment for renal or ureteral stones during the performance period. The cost measure score is the clinician’s risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician. This procedural measure includes costs of services that are clinically related to the attributed clinician’s role in managing care during each episode from 90 days prior to the clinical event that opens, or “triggers,” the episode through 30 days after the trigger.

    Collection Type

    • Administrative claims measures

    Measure ID

    COST_RUSST_1

  • Revascularization for Lower Extremity Chronic Critical Limb Ischemia

    A clinician’s risk-adjusted cost to Medicare for beneficiaries who undergo elective revascularization surgery for lower extremity chronic critical limb ischemia during the performance period. Includes costs of services that are clinically related to the attributed clinician’s role in managing care from 30 days prior to the revascularization procedure that triggers the episode through 90 days after the trigger.

    Collection Type

    • Administrative claims measures

    Measure ID

    COST_CCLI_1

  • Routine Cataract Removal with Intraocular Lens (IOL) Implantation

    A clinician’s risk-adjusted cost to Medicare for beneficiaries who undergo a procedure for routine cataract removal with IOL implantation during the performance period. Includes costs of services that are clinically related to the attributed clinician’s role in managing care from 60 days prior to the cataract removal procedure that triggers the episode through 90 days after the trigger.

    Collection Type

    • Administrative claims measures

    Measure ID

    COST_IOL_1

  • Screening/Surveillance Colonoscopy

    A clinician’s risk-adjusted cost to Medicare for beneficiaries who receive a screening/surveillance colonoscopy. Includes costs of services that are clinically related to the attributed clinician’s role in managing care from the screening/surveillance colonoscopy procedure that triggers the episode through 14 days after the trigger.

    Collection Type

    • Administrative claims measures

    Measure ID

    COST_SSC_1

  • Simple Pneumonia with Hospitalization

    A clinician’s risk-adjusted cost to Medicare for beneficiaries hospitalized with simple pneumonia during the performance period. Includes costs of services that are clinically related to the attributed clinician’s role in managing care from the inpatient hospitalization that triggers the episode through 30 days after the trigger.

    Collection Type

    • Administrative claims measures

    Measure ID

    COST_SPH_1

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

    A clinician’s risk-adjusted cost to Medicare for beneficiaries who present with STEMI, indicating complete blockage of a coronary artery, who emergently receive PCI as treatment during the performance period. Includes costs of services that are clinically related to the attributed clinician’s role in managing care from the inpatient hospitalization that triggers the episode through 30 days after the trigger.

    Collection Type

    • Administrative claims measures

    Measure ID

    COST_STEMI_1

  • Total Per Capita Costs (TPCC)

    The overall, payment-standardized, annualized, risk-adjusted, and specialty-adjusted cost of care provided to beneficiaries attributed to their primary care clinicians.

    Collection Type

    • Administrative claims measures

    Measure ID

    TPCC_1