MIPS Cost Performance Category

MIPS Cost Performance Category (2025)

For the 2025 performance year, eligible clinicians and groups may receive a Cost performance category score that accounts for 30% of their final MIPS score. ECs and groups do not need to submit data or attest to anything for this category. Instead, CMS uses claims data to assess an individual or group's performance during the performance year.

In 2025, CMS will use administrative claims data to assess individual ECs and their groups on the cost measures below. Attribution of individual ECs or groups to these measures is often dependent upon the plurality of services and costs provided to individual patients for these measures. If an EC or group is unable to be scored in the Cost category, the 30% weighting will be redistributed to another performance category or categories and most likely the Quality performance category. If you are in a small group different redistribution policies may apply.

CMS will calculate the cost performance category at the category level without using statistical significance. CMS indicated that this updated methodology will ensure mathematical and operational feasibility to allow for the cost performance category to be scored. 

Facility-based measurement scoring will be used for your quality and cost performance category scores when all the following conditions are met: 1.) You're identified as facility-based; and 2.) You're attributed to a facility with a Hospital Value-Based Purchasing (VBP) Program score. The MIPS quality and cost performance category scores will be based on the facility-based measurement scoring methodology unless a clinician or group receives a higher MIPS final score through another MIPS submission.

Population-based cost measures:
Medicare spending per beneficiary (MSPB)
Total per capita cost (TPCC)

Procedural episode-based cost measures:
Elective outpatient percutaneous coronary intervention (PCI)
Knee arthroplasty
Revascularization for lower extremity chronic critical limb ischemia
Routine cataract removal with intraocular lens (IOL) implantation
Screening/surveillance colonoscopy
Acute Kidney Injury Requiring New Inpatient Dialysis
Elective Primary Hip Arthroplasty
Femoral or Inguinal Hernia Repair
Hemodialysis Access Creation
Lumbar Spine Fusion for Degenerative Disease, 1-3 levels
Lumpectomy, Partial Mastectomy, Simple Mastectomy
Non-Emergent Coronary Artery Bypass Graft (CABG)
Renal or Ureteral Stone Surgical Treatment
Melanoma Resection
Colon and Rectal Resection

Acute inpatient medical condition episode-based cost measures:
Intracranial hemorrhage or cerebral infarction (Acute inpatient medical condition)
ST-Elevation myocardial infarction (STEMI) with percutaneous coronary intervention (PCI) (Acute inpatient medical condition)
Inpatient Chronic Obstructive Pulmonary Disease (COPD) Exacerbation
Lower Gastrointestinal Hemorrhage (at group level only)
Psychoses and Related Conditions (care episode groups)
Sepsis
Respiratory Infection Hospitalization

Chronic condition episode-based cost measures:
Asthma/Chronic Obstructive Pulmonary Disease (COPD)
Depression (patient condition groups)
Diabetes
Heart Failure (patient condition groups)
Low Back Pain (patient condition groups)
Chronic Kidney Disease
End-Stage Renal Disease
Kidney Transplant Management
Prostate Cancer
Rheumatoid Arthritis

Cost measure specifications and regulatory information are available on the Quality Payment Program website. ASA continues to advocate for physician anesthesiologists to be fairly and accurately assessed under the MIPS cost category.