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 Current Procedural Terminology (CPT) Modifiers for reporting patient relationship codes.
• View slides, transcripts, recordings and FAQs from the 2/21/18 and the 10/17/18 Patient Relationship Categories & Codes webinars.  

2022 Physician Fee Schedule Proposed Rule resources

• 2022 cost measure codes lists (ZIP) that detail the cost measure codes list for each of the 5 new episode-based cost measures developed during Wave 3 that have been proposed for the Calendar Year (CY) 2022 Physician Fee Schedule proposed rule.
• 2022 cost measure information forms (ZIP) that detail the measure methodology for each of the 5 new episode-based cost measures developed during Wave 3 that have been proposed for the CY2022 Physician Fee Schedule proposed rule.

2021 Merit-based Incentive Payment System (MIPS) cost performance category resources

• 2021 cost measure codes lists (ZIP) detail the cost measure codes list for each of the 18 episode-based cost measures and the revised Medicare Spending Per Beneficiary (MSPB) Clinician and Total Per Capital Cost (TPCC) measures that are in use for the cost performance category in 2021. 
• 2021 cost measure information forms (ZIP) detail the measure methodology for each of the 18 episode-based cost measures and the revised MSPB Clinician and TPCC measures that are in use for the Cost performance category in 2021.
• 2021 MIPS Summary of Cost Measures (PDF) provides a summary of cost measures in use for MIPS in 2021 as well as measures under development.

Chronic Kidney Disease/End-Stage Renal Disease (CKD/ESRD) cost measure development (2021-2022)

• CKD/ESRD Clinician Expert Workgroup Compositon List (PDF) is the list of members of the workgroup that met in 9/2021 to give detailed clinical input on the measure specifications for the CKD/ESRD measures.

Psychoses/Related Conditions cost measure refinement (2019-2022)

• Psychoses/Related Conditions Clinician Expert Workgroup Composition List (PDF) is the list of members of the workgroup that met in 10/2021 to give detailed clinical input on potential refinements to the Psychoses/Related Conditions measure.

Wave 4 cost measure development (2021-2022)

• Wave 4 Public Comment Summary (PDF) describes stakeholder input received during the Wave 4 public comment period on candidate measure areas, which was held from December 15, 2020 to February 5, 2021, and provides brief responses to feedback.
• Summary of Wave 4 Workgroup meetings (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held in 6/2021. Workgroup members gave detailed input on each component of the cost measure, including:
  • Defining the episode group
  • Addressing patient sub-populations for meaningful clinical comparison
  • Assigning services to the episode group
• Wave 4 Measure-Specific Workgroup Composition List (PDF) is the list of members of the measure-specific workgroups that met in 6/2021 to give detailed clinical input on the measure specifications for the 4 episode groups being developed in Wave 4.

Wave 3 cost measure development (2019-2020)

• Summary of Wave 3 Clinical Subcommittee (CS) meetings (ZIP) contains a high-level summary of each of the Clinical Subcommittee meetings held from 5/2019 - 6/2019. 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 (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held in 8/2019. 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
• Summary of Wave 3 Service Assignment & Refinement (SAR) Workgroup meetings (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held in 1/2020. Workgroup members gave input on:
  • Assigning services to the episode group
  • Potential refinements to the measure specifications before national field testing
• Summary of Wave 3 Post-Field Test Refinement (PFTR) Workgroup meetings (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held in 10/2020. Workgroup members gave input on:
  • Refinements to the measure specifications based on feedback received during national field testing
  • Impact of COVID-19 on measure specifications 
• Wave 3 Measure-Specific Workgroup Composition List (PDF) is the list of members of the measure-specific workgroups that met in 8/2019 to give detailed clinical input on the measure specifications for the 5 episode groups being developed in Wave 3.
• Summary of Person and Family Engagement (PFE) and Input (PDF) contains a summary of how PFE has been incorporated in measure specifications for the Wave 3 measures.

Learn about the cost measures & the development process

Stakeholders have had many opportunities to provide input throughout the process. Learn more about the MACRA cost measure development process from:

• Waves 1 & 2 measure development process (PDF) describes our approach to Waves 1 and 2 of 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.
• Shared Data Across Cost Measurements (PDF) shows how claims data is shared within and across cost measures and is intended to address stakeholders' questions about "double counting."
• Chronic Condition Cost Measure Framework poster (PDF) provides information on the chronic condition episode-based cost measure framework and describes how the framework captures the costs of care to meet the MACRA mandate.

Learn about the cost measures developed in Wave 2:

• The Wave 2 Measure Justification Forms (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.
• 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.

Learn more about the cost measures developed in Wave 3:

• Wave 3 Measure Development Process (PDF) describes our approach to measure development.
• The Wave 3 Measure Justification Forms (ZIP) contain Measure Justification Forms for the 5 episode-based cost measures that provide a comprehensive characterization of the measures, their justification, and testing results.
• Updated 2020 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.
• Testing Updates for Wave 3 (PDF) provides updated information on empirical validity for the Wave 3 measures, including relationship to related MIPS quality measure and the global cost of care TPCC measure.

Learn about the Care Episode & Patient Condition Codes

• 2021 Operational List of Care Episode & Patient Condition Codes (XLSX) includes revisions as proposed in the CY 2022 Physician Fee Schedule proposed rule.

• 2020 Operational List of Care Episode & Patient Condition Codes (XLSX) includes 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)
• Prior cost measure field testing:
  • 2017 Field Testing materials (ZIP) contain field testing documents for the 8 episode-based cost measures that were developed in Wave 1 and field tested from 10/16/2017 - 11/20/2017. During that time, we collected feedback (PDF) from stakeholders to refine the measures before we decided whether to use them in MIPS.
  • 2018 Field Testing materials (ZIP) contain field testing documents for the 11 Wave 2 episode-based cost measures and 2 revised measures that were field tested between 10/3/2018 - 11/05/2018. During that time, we collected feedback (PDF) from stakeholders to refine the measures before we decided whether to use them in MIPS.
  • 2020 Field Testing materials (ZIP) contain field testing documents for the 5 Wave 3 episode-based cost measures that were field tested between 8/17/2020 - 09/18/2020. During that time, we collected feedback (PDF) from stakeholders to refine the measures before we decided whether to use them in MIPS.
• 2018 study on burdens associated with reporting quality measures (PDF) to get improvement activity credit for 2018.
• The MACRA Request For Information (RFI) (PDF).
• 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) (12/2016).