2022 MIPS Cost Performance Category

The cost performance category is an important part of MIPS. Although clinicians don’t personally determine the price of individual services provided to Medicare patients, they can affect the amount and types of services provided. By better coordinating care and seeking to improve health outcomes by ensuring their patients receive the right services, clinicians play a meaningful role in delivering high-quality care at a reasonable cost.

Cost Measures

There are 25 total cost measures for the 2022 performance period. CMS uses Medicare claims data to calculate cost measure performance which means clinicians do not have to submit any data for this performance category

Measure Name

Description

Case Minimum

Data Source

Total Per Capita Cost (TPCC)

This population-based measure assesses the overall cost of care delivered to a Medicare patient with a
focus on primary care received.

20 Medicare patients

 

•Medicare Parts A and B claims
data

 

Medicare Spending Per Beneficiary Clinician (MSPB Clinician)

This population-based measure assesses the cost of care for services related to qualifying inpatient hospital stay (immediately prior to, during, and after) for a Medicare patient

35 episodes

 

•Medicare Parts A and B claims data

 

15 procedural episode-based
measures

Assess the cost of care that’s clinically related to a specific procedure provided during an episode’s timeframe.10 episodes for all procedural episode-based measures except the Colon and Rectal Resection measure which has a case minimum of 20 episodes.

 

•Medicare Parts A and B claims data

 

6 acute inpatient medical condition episode-based measuresAssess the cost of care clinically related to specific acute inpatient medical conditions and provided during an episode’s timeframe.20 episodes for acute inpatient condition episode based measures•Medicare Parts A and B claims data
2 chronic condition episode based measuresAssess the cost of care clinically related to the care and management of patients’ specific chronic conditions provided during a total attribution window divided into episodes.20 episodes for chronic condition episode-based measures•Medicare Parts A, B and D claims data


Procedural episode-based measures

Measure Name

Measure Type

Episode Window

This Measure Evaluates a Clinician’s Risk Adjusted Cost to Medicare for…

Measures Can Be Triggered Based on Claims Data from the Following Settings:

Elective Outpatient Percutaneous Coronary Intervention (PCI)

Procedural

Pre-Trigger Period = 0 days

Post-Trigger Period = 30 days

Patients who undergo elective outpatient PCI surgery to place a coronary stent for heart disease during the performance period.Ambulatory/office-based care centers, outpatient hospitals,
Ambulatory surgical centers (ASCs)

Knee Arthroplasty

Procedural

Pre-Trigger Period = 30 days

Post-Trigger Period = 90 days

Patients who receive an elective knee arthroplasty during the
performance period.

Acute inpatient (IP) hospitals, hospital outpatient department (HOPDs), ambulatory/office-based care centers, and ASCs

Revascularization for Lower Extremity Chronic Critical Limb Ischemia

Procedural

Pre-Trigger Period = 30 days

Post-Trigger Period = 90 days

Patients who undergo elective revascularization surgery for lower extremity chronic critical limb ischemia during the performance period.ASCs, HOPDs and acute IP hospitals

Routine Cataract Removal with Intraocular Lens (IOL) Implantation

Procedural

Pre-Trigger Period = 60 days

Post-Trigger Period = 90 days

Patients who undergo a procedure for routine cataract removal with intraocular lens implantation during the performance period.ASCs, ambulatory/office-based care, and HOPDs

Screening/Surveillance Colonoscopy

Procedural

Pre-Trigger Period = 0 days

Post-Trigger Period = 14 days

Patients who undergo a screening or surveillance colonoscopy
procedure during the performance period.
ASCs, ambulatory/office-based care, HOPDs

Acute Kidney Injury Requiring New Inpatient Dialysis

Procedural

Pre-Trigger Period = 0 days

Post-Trigger Period = 30 days

PPatients who receive an inpatient dialysis service for acute kidney injury during the performance period.

Acute IP hospitals

Elective Primary Hip Arthroplasty

Procedural

Pre-Trigger Period = 30 days

Post-Trigger Period = 90 days

Patients who receive an elective primary hip arthroplasty during the performance period.Acute IP hospitals, HOPDs, ambulatory/office-based care
centers, and ASCs

Femoral or Inguinal Hernia Repair

Procedural

Pre-Trigger Period = 30 days

Post-Trigger Period = 90 days

Patients who undergo a surgical procedure to repair a femoral or inguinal hernia during the performance period.Acute IP hospitals, HOPDs, ambulatory/office-based care centers, and ASCs

Hemodialysis Access Creation

Procedural

Pre-Trigger Period = 60 days

Post-Trigger Period = 90 days

Patients who undergo a procedure for the creation of graft or fistula access for long-term hemodialysis during the performance period.Ambulatory/office-based care centers, OP hospitals, and
ASCs

Lumbar Spine Fusion for Degenerative Disease, 1-3 Levels

Procedural

Pre-Trigger Period = 30 days

Post-Trigger Period = 90 days

Patients who undergo surgery for lumbar spine fusion during the performance period.ASCs, HOPDs, and acute IP hospitals

Lumpectomy Partial Mastectomy, Simple Mastectomy

Procedural

Pre-Trigger Period = 30 days

Post-Trigger Period = 90 days

Patients who undergo partial or total mastectomy for breast cancer during the performance period.Ambulatory/office-based care centers, outpatient hospitals,
and ASCs

Non-Emergent Coronary Artery Bypass Graft (CABG)

Procedural

Pre-Trigger Period = 30 days

Post-Trigger Period = 90 days

Patients who undergo a CABG procedure during the performance period.Acute IP hospitals

Renal or Ureteral Stone Surgical Treatment

Procedural

Pre-Trigger Period = 90 days

Post-Trigger Period = 30 days

Patients who receive surgical treatment for renal or ureteral
stones during the performance period.
Acute IP hospitals, HOPDs, ambulatory/office-based care
centers, and ASCs
Melanoma ResectionProceduralPre-Trigger Window: 30 days

Post-Trigger Window: 90 days
Patients who undergo an excision procedure to remove
a cutaneous melanoma during the performance period.
ASCs, ambulatory/office-based care, and HOPDs.
Colon and Rectal ResectionProceduralPre-Trigger Window: 15 days

Post-Trigger Window: 90 days
Patients who receive colon or rectal resection for either
benign or malignant indications during the performance period.
ASCs, HOPDs, and acute IP hospitals.

Acute inpatient medical condition episode-based measures

Measure Name

Measure Type

Episode Window

This Measure Evaluates a Clinician’s Risk Adjusted Cost to Medicare for…

Measures Can Be Triggered Based on Claims Data from the Following Settings:

Intracranial Hemorrhage or Cerebral Infarction

Acute inpatient medical condition

Pre-Trigger Period = 0 days

Post-Trigger Period = 90 days

Patients who receive inpatient treatment for cerebral infarction or intracranial hemorrhage during the performance period.Acute IP hospitals

Simple Pneumonia with Hospitalization

Acute inpatient medical condition

Pre-Trigger Period = 0 days

Post-Trigger Period = 30 days

Patients who receive inpatient treatment for simple pneumonia during the performance period.Acute IP hospitals

ST-Elevation Myocardial Infarction (STEMI) with Percutaneous Coronary Intervention (PCI)

Acute inpatient medical condition

Pre-Trigger Period = 0 days

Post-Trigger Period = 30 days

Patients who present with STEMI indicating complete blockage of a coronary artery who emergently receive PCI as treatment during the performance period.Acute IP hospitals

Inpatient Chronic Obstructive Pulmonary Disease (COPD) Exacerbation

Acute inpatient medical condition

Pre-Trigger Period = 0 days

Post-Trigger Period = 60 days

Patients who receive inpatient treatment for an acute
exacerbation of COPD during the performance period.
Acute IP hospitals

Lower Gastrointestinal Hemorrhage (applies to groups only)

Acute inpatient medical condition

Pre-Trigger Period = 0 days

Post-Tigger period = 35 days

Patients who receive inpatient non-surgical treatment for acute bleeding in the lower gastrointestinal tract during the performance period.Acute IP hospitals
SepsisAcute inpatient medical conditionPre-Trigger Window: 0 days

Post-Trigger Window: 45 days
Patients who receive inpatient medical treatment for sepsis
during the performance period.
Acute IP hospitals.

Chronic medical condition episode-based measures

Measure Name

Measure Type

Episode Window

This Measure Evaluates a Clinician’s Risk Adjusted Cost to Medicare for…

Measures Can Be Triggered Based on Claims Data from the Following Settings:

Diabetes

Chronic condition

An episode is a segment of time during which clinicians
or clinician groups are assessed for the care that
they provide to a patient with diabetes.
The episode window length for the Diabetes measure is
between 1 year (365 days) and 2 years minus 1 day (729
days) and can vary in length across patients.

Patients receiving medical care to manage and treat diabetes.
This chronic condition measure includes the costs of services that are clinically related to the attributed clinician’s role in managing care during a Diabetes episode.
The measure focuses on care provided by clinicians practicing in non-IP hospital settings for patients with diabetes. The most frequent settings in which a Diabetes episode is triggered include: 
Office, Skilled Nursing Facility (SNF), and OP Hospital.

Asthma/Chronic Obstructive Pulmonary Disease (COPD)

Chronic conditionAn episode is a segment of time during which clinicians or clinician groups are assessed for the care that they provide to a patient with asthma or COPD.

The episode window length for the Asthma/COPD measure is between 1 year (365 days) and 2 years minus 1 day (729 days) and can vary in length across patients.
Patients receiving medical care to manage and treat asthma or COPD. This chronic condition measure includes the costs of services that are clinically related to the attributed clinician’s role in managing care during an Asthma/COPD episode.The measure focuses on care provided by clinicians practicing in non-IP hospital settings for patients with asthma or COPD. The most frequent settings in which an Asthma/COPD episode is triggered include:
Office, SNF, and OP Hospital.

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