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:

2025 Physician Fee Schedule Proposed Rule resources

• 2025 cost measure codes lists (ZIP)that detail the cost measure codes list for each of the 8 episode-based cost measures (5 developed in Wave 5 and 3 reevaluated cost measures) that have been proposed for the Calendar Year (CY) 2025 Physician Fee Schedule proposed rule. 
• 2025 cost measure information forms (ZIP) that detail the measure methodology each of the 8 episode-based cost measures (5 developed in Wave 5 and 3 reevaluated cost measures) that have been proposed for the CY 2025 Physician Fee Schedule proposed rule.

Care episode & patient condition codes

• 2025 Operational List of Care Episode & Patient Condition Codes (XLSX) includes revisions as proposed in the CY 2025 Physician Fee Schedule proposed rule to include eight new or revised episode-based cost measures.
• Prior operational lists (ZIP) contains operational lists of care episode & patient condition codes posted in 2018, 2020, 2021, 2022, and 2023.

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.

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.
• 2022-2024 MIPS Cost Measures FAQ (PDF) answers key questions about MIPS cost measures in use for the 2022, 2023, and 2024 performance periods.

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.