Cost Scoring Logic

For 2025 MIPS Performance period, the Cost category has a weight of 30% in overall MIPS score.

6 episode-based cost measures are added beginning with the 2025 performance period for implementation at the group (TIN) and clinician (TIN/NPI) level with a 20- episode case minimum.

A new cost measure exclusion policy will be implemented beginning with the CY 2025 performance period.

The cost scoring benchmarking methodology will be revised starting in 2025 performance period. (These changes will take effect when 2025 final scores are released in June 2025).

CMS will calculate Cost category score based on administrative claims data. Individual MIPS eligible clinicians and groups don’t have to submit any other information for the Cost performance category.