About cost measures & development process

Episode-based cost measures are developed and maintained in iterative processes involving in-depth input from content experts and the public. Learn more about cost measures and the measure development process from:

2024 MIPS cost performance category resources

• 2024 Cost Measure Information Forms (ZIP) detail the cost measure methodology for each of the 27 episode-based cost measures and the revised Medicare Spending Per Beneficiary (MSPB) Clinician measure, and the Total Per Capita Cost (TPCC) measures that are in use for the cost performance category in 2024.
• 2024 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 measure and the TPCC measures that are in use for the cost performance category in 2024.
• 2024 MIPS Summary of Cost Measures (PDF) provides a summary of cost measures in use for MIPS in 2024 as well as measures under development.

Care episode & patient condition codes 

• 2024 Operational List of Care Episode & Patient Condition Codes (XLSX) includes revisions as finalized in the Calendar Year (CY) 2024 Physician Fee Schedule final rule to include five new episode-based cost measures and remove Simple Pneumonia with Hospitalization.
• Prior operational lists (ZIP) contains operational lists of care episode & patient condition codes posted in 2018, 2020, 2021, and 2022.

General information about cost measures 

• 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.
• MIPS Chronic Condition Episode-Based Cost Measures Attribution Methodology (ZIP) contains a one-pager and the Frequently Asked Questions (FAQ) document describing the attribution methodology used for chronic condition episode-based cost measures.
• 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.

About the measure development process

• Input Opportunities (PDF) lists many ways to participate in the development process.
• Person & Family Committee Guiding Principles (PDF) shows high-level guiding principles developed from structured patient and caregiver interviews to inform cost measure development.