2. What is an episode-based cost measure? Episode-based cost measures are measures that assess costs for episodes of care that represent a variety of conditions and procedures that are designated as high cost, have variability in resource use, or are for high impact conditions. CMS will be assessing performance for 23 episode-based measures, when applicable to the clinician. These 23 episode-based measures are illustrated in the chart below: Measure Category Attribution and Case Minimum Measure Procedural Episodes Attribution to each MIPS eligible clinician (EC) who renders a trigger service as identified by HCPCS/CPT code. The case minimum would be 10 episodes for these measures. Elective outpatient percutaneous coronary intervention 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 Renal or Ureteral Stone Surgical Treatment Melanoma Resection Colon and Rectal Resection Acute inpatient medical condition episodes Attribution to each MIPS EC who bills inpatient E/M claim lines during trigger inpatient hospitalization (i.e., an MS-DRG identifying the episode group) under a TIN that renders at least 30% of inpatient E/M claim lines in that hospitalization. The case minimum would be 20 episodes for these measures. Intracranial hemorrhage or cerebral infarction Simple pneumonia with hospitalization ST-elevation myocardial infarction infarction (STEMI) with PCI Inpatient Chronic Obstructive Pulmonary Disease Exacerbation Lower Gastrointestinal Hemorrhage Sepsis Chronic Condition Episodes Attributed to the clinician group that renders services that make up a "trigger event." A trigger event for chronic condition episode-based measures is identified by the occurrence of 2 claims billed in close proximity by the same clinician group. The case minimum would be 20 episodes for these measures. Diabetes Asthma/Chronic Obstructive Pulmonary Disease (COPD) Pages MIPS Cost1. How do I know how I or my group compares on cost/resource use?2. What is an episode-based cost measure?3. What data will I need to submit for the cost category?4. What are the patient relationship codes?5. How do risk adjustment factors impact the cost category? Comments are closed.