We need your feedback & comments
The MACRA required us to ask for your feedback.
How can I learn about the Patient Relationship Categories & Codes?
- Read more (PDF), based on your comments, about patient relationship categories and how we may use CPT Modifiers for reporting patient relationship codes.
- View slides, transcripts, and recordings and an FAQ from the 2/21/18 and the 10/17/18 Patient Relationship Categories & Codes webinars.
2019 MIPS cost performance category resources
- 2019 cost measure code lists that detail the cost measure code lists for each of the 8 episode-based cost measures that are new for the Cost performance category in 2019.
- 2019 cost measure information forms (ZIP) that detail the measure methodology for each of the 8 episode-based cost measures that are new for the Cost performance category in 2019 and provides an overview of the 2019 TPCC and MSPB cost measures that were established for the Merit-based Incentive Payment System (MIPS) in 2018.
- 2019 Merit-based Incentive Payment System (MIPS): Summary of cost measures. This provides a summary of cost measures in relation to MIPS.
MACRA cost measure development (Wave 2 - 2018)
In October 2018, we field tested 11 newly developed episode-based cost measures and 2 revised measures for consideration in MIPS. Field testing happened from October 3, 2018 - October 31, 2018, with an extension to November 5, 2018. During field testing clinicians and clinician groups were able to get Field Test Reports from the CMS Enterprise Portal and give feedback on the draft measure specifications, field test report templates, and supplemental documentation. These reports were for field testing only, and don’t affect any scoring or payment adjustments.
Note: Field test reports are no longer available on the CMS Enterprise Portal, as of January 2019.
You can review our:
- Fact sheet (PDF), which gives you basic information about the cost measures and the field testing process.
- FAQs (PDF), which provide more information on these topics in a question and answer format.
- Sample Mock Field Test Reports for each of the measures that were field tested:
You can also review current measure specifications, measure justification forms, and supplemental documents for the 11 episode-based cost measures and the revised TPCC and MSPB measures, including refinements based on field testing feedback:
- The Episode-Based Cost Measures zip file (ZIP) includes a cost measure methodology document and a measure codes list file for each of the 10 episode-based cost measures that were finalized in the CY 2020 Physician Fee Schedule Final Rule.
- The revised MSPB clinician zip file (ZIP) includes a cost measure methodology document and a measure codes list file for the revised measure that was finalized in the CY 2020 Physician Fee Schedule Final Rule.
- The revised TPCC zip file (ZIP) includes a cost measure methodology document and measure codes list file for the revised measure that was finalized in the CY 2020 Physician Fee Schedule Final Rule.
- The Measure Justification Forms zip file (ZIP) contains Measure Justification Forms for the 11 episode-based cost measures and the revised TPCC and MSPB measures that contain a comprehensive characterization of the measures, their justification, and testing results.
- Updated 2018 National Summary Data Report (ZIP) contains an updated report that provides national-level summary statistics on clinicians’ performance for the cost measures following refinements made after the field testing period, as well as an addendum with risk adjustment regression results for the cost measures.
- The Field Testing Feedback Summary Report (PDF) provides a summary of feedback and refinements made to the cost measures after the field testing period.
- Person and Family Committee (PFC) Input for Wave 2 Episode-Based Cost Measure Development (PDF) is a summary of input we got from the PFC on the 11 episode-based cost measures developed in Wave 2.
MACRA cost measure development (Wave 3 - 2019)
- Wave 3 Clinical Subcommittee Meeting Summaries file (ZIP) contains a high-level summary of each of the Clinical Subcommittee (CS) meetings held in May-June 2019. CS members gave input on:
- Episode groups to develop into cost measures
- Specialties that should be represented in the workgroups that give detailed input for each episode group approved for development
- Summary of Wave 3 Workgroup meetings file (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held in August 2019. Workgroup members gave detailed input on each component of the cost measure that the CS selected for development, including:
- Defining the episode group
- Addressing patient sub-populations for meaningful clinical comparison
- Assigning services to the episode group
- Wave 3 Measure-Specific Workgroup Composition List (PDF) is the list of members of the measure-specific workgroups that met in August 2019 to give detailed clinical input on the measure specifications for the 5 episode groups being developed in Wave 3.
Learn about the cost measure development process
There have been many opportunities for stakeholders to provide input throughout the process. Learn more about the MACRA cost measure development process from:
- Measure development process document (PDF) describes our approach to episode-based cost measure development.
- Person & Family Committee Guiding Principles (PDF) shows high-level guiding principles developed from structured patient and caregiver interviews to inform cost measure development.
- Stakeholder Input Opportunities (PDF) lists many ways to participate in the development process.
Learn about the Care Episodes & Patient Condition Codes
- 2020 Operational List of Care Episode & Patient Condition Codes (XLSX). These include revisions as finalized in the CY 2020 Physician Fee Schedule Final Rule.
Prior feedback requests:
- 2018 Operational List of Care Episode & Patient Condition Codes (ZIP) (1/23/2018)
- Previous Cost Measure Field Testing
- 2018 study on burdens associated with reporting quality measures (PDF) to get Improvement Activity credit for 2018.
- The MACRA RFI.
- The Draft CMS Quality Measure Development Plan (MDP) (PDF).
- Annual call for measures & activities. You can read our fact sheet (ZIP) and attend our webinar for a walkthrough of the process.
- Previous episode groups summary and details (ZIP), and supplemental episode groups materials (ZIP).
- Draft list of episode groups and trigger codes (ZIP) (December 2016).