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, 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.
- Wave 3 Cost Measures Field Testing Webinar recording.
- Fact sheet (PDF) has basic information about the cost measures and field testing process.
- FAQ (PDF) gives you information about the cost measures and field testing in a question and answer format.
- Wave 3 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 3 sample Field Test Reports that are representative of each measure type and reporting level. Each Field Test Report includes a supplemental CSV file with episode-level data along with the data dictionary for the metrics used in the CSV.
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 draft cost measure methodology and draft cost measure codes lists for each of the 5 episode-based cost measures under development. Section 3 of each of draft measure methodology document contains a high-level, one-page summary of the measure specifications.
- Medicare Part D Standardization Methodology (PDF) describes the draft methodology for producing standardized Part D claim payment amounts for the episode-based cost measures that include drug costs.
- Episode-Based Cost Measure Part D Rebate Adjustment Methodology (PDF) details the draft methodology used to incorporate rebates into standardized amounts for Part D drugs during field testing.
- Questions for Field Testing Measure Specifications (PDF) has questions on the specifications of each of the measures as included in the online survey, and accompanies the draft specifications for each measure.
- Measure Testing Forms (ZIP) has detailed testing results for the 5 episode-based cost measures.
- National Summary Data Report (PDF) gives national-level summary statistics for the 5 episode-based cost measures.
- Field Testing Feedback Summary Report (PDF) provides a summary of feedback and refinements made to the cost measures after the field testing period.
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:
- 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."
Learn about the cost measures developed in Wave 2:
- The 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 about the Care Episode & Patient Condition Codes
- 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) contains 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) contains 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.
- 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).