We need your feedback & comments

The MACRA required us to ask for your feedback.

2023 MIPS cost performance category resources

• 2023 Cost Measure Information Forms (ZIP) detail the cost measure methodology for each of the 23 episode-based cost measures and the revised Medicare Spending Per Beneficiary (MSPB) Clinician and Total Per Capita Cost (TPCC) measures that are in use for the cost performance category in 2023.
• 2023 Cost Measure Codes Lists (ZIP) detail the cost measure codes list for each of the 23 episode-based cost measures and the revised MSPB Clinician and TPCC measures that are in use for the cost performance category in 2023.
• 2023 MIPS Summary of Cost Measures (PDF) provides a summary of cost measures in use for MIPS in 2023 as well as measures under development.

Wave 5 cost measures field testing

From January 17 to February 14, 2023, we are field testing 5 newly developed Wave 5 episode-based cost measures for consideration in MIPS. During field testing, eligible clinicians and clinician groups ere able to download their Field Test Reports from the Quality Payment Program website and give feedback on the draft measure specifications. These reports are for field testing only, and don’t affect any scoring or payment adjustments.

Learn more:

• Frequently Asked Questions (FAQ) (PDF) gives you information about the cost measures and field testing in a question and answer format.
• Wave 5 Measure Development Process (PDF) describes our approach to measure development.
• User Access Guide (PDF) explains how to access your Field Test Report(s) on the Quality Payment Program website.
• Mock Field Test Reports (ZIP) contains sample Field Test Reports that are representative of each reporting level. Each zip file includes a PDF Field Test Report, a supplemental comma-separated values (CSV) file with episode-level data, and the data dictionary for the metrics used in the CSV file.

You can also review the measure specifications, measure testing forms, and supplemental documents for the 5 episode-based cost measures:

• Episode-Based Cost Measure Specifications (ZIP) includes the cost measure methodology and cost measure codes lists for each of the 5 episode-based cost measures developed or respecified during Wave 5. Section 3 of each measure methodology document contains a high-level summary of the measure specifications.
• Questions for Field Testing Measure Specifications (PDF) contains questions on the specifications of each of the measures as included in the online survey, and accompanies the draft specifications for each measure.
• Person and Family Engagement Cost Measures Field Testing Feedback Survey contains questions on the measures being field tested as included in the online survey, and it is intended for patient and family/caregiver input.
• Measure Testing Forms (ZIP) has detailed testing results for the 5 episode-based cost measures.

Wave 5 cost measure development (2022-2023)

• Wave 5 Public Comment Summary Report (PDF) describes input received during the Wave 5 pubic comment period on candidate measure areas, which was held from February 18, 2022 to April 1, 2022, and provides brief responses to feedback.
• Summary of Wave 5 Workgroup Meeting (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held in in 7/2022. 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
• Summary of Wave 5 Service Assignment and Refinement (SAR) Workgroup Meetings (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held in 9/2022 and 10/2022. Workgroup members gave input on:
  • Assigning services to the episode group
  • Potential refinements to the measure specifications before national field testing
• Wave 5 Measure-Specific Workgroup Composition List (PDF) is the list of members of the measure-specific workgroups that met in 7/2022 to give detailed clinical input on the measure specifications for the 3 episode groups being developed in Wave 5.

Wave 1 cost measure comprehensive reevaluation (2022-2023)

From February 1 to February 28, 2023, we are requesting input on potential revisions to 3 episode-based cost measures undergoing comprehensive reevaluation before consideration of their use in the Merit-Based Incentive Payment System (MIPS):

• Cataract Removal with Intraocular Lens (IOL) Implantation (currently Routine Cataract Removal with Intraocular Lens (IOL) Implantation)
• Inpatient Percutaneous Coronary Intervention (PCI) (currently ST-Elevation Myocardial Infarction [STEMI] with PCI)
• Respiratory Infection Hospitalization (currently Simple Pneumonia with Hospitalization)

Note: These potential revisions would not take effect in performance years 2023 or 2024. Any revisions would go through the pre-rulemaking and rulemaking process before potential use in performance year 2025. The current version of the measures remains in use in MIPS until any revisions are finalized.

You may provide feedback via online survey now through 11:59 PM ET on February 28, 2023, on the draft updates to measure specifications. Please feel free to share this message with anyone who may be interested in these activities. Click on the link below to access the survey:

• 2023 Cost Measure Reevaluation Feedback Survey: Use this survey to provide input on potential measure revisions.

You can also review the measure specifications and supplemental documents:

• Episode-Based Cost Measure Specifications includes the cost measure methodology and cost measure codes lists for each of the 3 episode-based cost measures undergoing comprehensive reevaluation. Section 3 of each measure methodology document contains a high-level summary of the measure specifications.
• Measure Testing Forms has detailed testing results for the 3 episode-based cost measure.
• Summary of Wave 1 Comprehensive Reevaluation Workgroup meetings contains a high-level summary of each of the measure-specific workgroup meetings held in October 2022. Workgroup members gave input on potential revisions to cost measures undergoing comprehensive reevaluation.
• Wave 1 Measure-Specific Workgroup Composition List is the list of members of the measure-specific workgroups that met in October 2022 to give input on potential revisions to cost measure undergoing comprehensive reevaluation.
• Wave 1 Comprehensive Reevaluation Public Comment Summary Report (PDF) describes input received during the initial MACRA Episode-Based Cost Measures Comprehensive Reevaluation public comment period, which was held from February 25, 2022 to May 28, 2022.

Wave 4 cost measure development and refinement (2021-2022)

• Wave 4 Public Comment Summary (PDF) describes 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
• Summary of Psychoses/Related Conditions Workgroup Webinar (PDF) provides discussion summaries and high-level takeaways for the following topics:
  • Review of prior development activities
  • Cost measure framework and draft specifications
  • Outstanding concerns and potential refinements
• Summary of Wave 4 Service Assignment & Refinement (SAR) Workgroup meetings (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held on 9/2021 and 10/2021. Workgroup members gave input on:
  • Assigning services to the episode group
  • Potential refinements to the measure specifications before national field testing
• Summary of Wave 4 Post-Field Test Refinement Webinar (PFTR) Workgroup meetings (ZIP) contains a high-level summary of each of the measure-specific workgroup meetings held in 4/2022. Workgroup members gave input on:
  • Assigning services to the episode group
  • Potential refinements to the measure specifications after national field testing
• Summary of Psychoses/Related Conditions Post-Field Test Refinement (PFTR) Webinar (PDF) provides discussion summaries and high-level takeaways for the refinement topics based on field testing feedback
• 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.
• 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 Episode-Based Cost Measure Specifications (ZIP) includes the cost measure methodology and cost measure codes lists for each of the 5 episode-based cost measures developed or refined during Wave 4, including refinements made to the measures after consideration of field testing feedback. 

• Wave 4 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 of these measures’ final specifications.

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

• CKD/ESRD Clinician Expert Workgroup Composition 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.
• Summary of CKD/ESRD Workgroup Webinar (PDF) provides discussion summaries and high-level takeaways for the following topics:
  • Defining the episode group
  • Addressing patient sub-populations for meaningful clinical comparison
  • Assigning services to the episode group

Learn about the cost measures & the development process

Content experts and other interested members of the public have had many opportunities to provide input throughout the process. Learn more about the MACRA cost measure development process from:

• Person & Family Committee Guiding Principles (PDF) shows high-level guiding principles developed from structured patient and caregiver interviews to inform cost measure development.
• 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 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.
• Methodology for Incorporation of Rebates in Part D Standardized Amounts (PDF) provides information on how the Part D standardization methodology incorporates rebates into standardized amounts.

Please see below to learn about the cost measures developed in Wave 2:

• Waves 1 & 2 measure development process (PDF) describes our approach to Waves 1 and 2 of cost measure development.
• 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.

Please see below to 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 the relationship to related MIPS quality measure and the global cost of care TPCC measure.
• Summary of Wave 3 Clinical Subcommittee (CS) and Workgroup meetings & Wave 3 Measure-Specific Workgroup Composition List (ZIP) contains a high-level summary of each of the Clinical Subcommittee meetings and measure-specific workgroup meetings held from 5/2019 – 10/2020, and 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 Care Episode & Patient Condition Codes

• 2023 Operational List of Care Episode & Patient Condition Codes (XLSX) includes revisions as finalized in the Calendar Year (CY) 2023 Physician Fee Schedule final rule to include the Medicare Spending Per Beneficiary (MSPB) Clinical cost measure.

• Prior operational lists (ZIP) contains operational lists of care episode & patient condition codes posted in 2018, 2020, 2021, and 06/2022.

Prior feedback requests:

• 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)  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)  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) to refine the measures before we decided whether to use them in MIPS.
  • 2022 Field Tesing Materials contain field testing documents for the 5 Wave 4 episode-based cost measures that were field tested between 1/10/2022-3/25/2022. During that time, we collected feedback 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).

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.