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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.

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:

Learn about the 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

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Page Last Modified:
08/17/2021 01:10 PM