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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 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.  

2021 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 MSPB Clinician and TPCC measures that are in use for the Cost performance category in 2021. These files include updated codes for telehealth services for the 18 episode-based cost measures and the revised TPCC measure (as finalized in the CY 2021 Physician Fee Schedule Final Rule).
  • 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 3 cost measures field testing

From August 17 to September 18, 2020, we field tested 5 newly developed episode-based cost measures for consideration in MIPS. During field testing, eligible clinicians and clinician groups were able to get Field Test Reports from the Quality Payment Program website and give feedback on the draft measure specifications. These reports were for field testing only, and don’t affect any scoring or payment adjustments.

Learn more:

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

Wave 3 MACRA 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.

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 about the Care Episode & Patient Condition Codes

Prior feedback requests:

Page Last Modified:
01/05/2021 10:38 AM