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Centers for Medicare & Medicaid Services Quality Payment Program
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Policy Update: Excluded MIPS Cost Measure for 2023 MIPS Performance Period/2025 MIPS Payment Year

CMS identified that the Simple Pneumonia with Hospitalization episode-based cost measure warrants exclusion from our calculation of MIPS eligible clinicians’ scores under the cost performance category. Therefore, this measure won’t be included in CMS’ calculation of MIPS eligible clinicians’ scores under the cost performance category for the 2023 MIPS performance period/2025 MIPS payment year.

Our analysis of the 2023 performance period showed that the Simple Pneumonia with Hospitalization episode-based cost measure continues to be impacted by the introduction of a new diagnosis code for pneumonia due to COVID-19 and additional guidance requiring that we report these instances as secondary to COVID-19. Empirical testing showed that these coding changes impacted the scope of pneumonia cases captured by this measure, greatly affecting the number of MIPS eligible clinicians that could meet the case minimum requirements for the measure and indicating that the measure isn’t assessing clinicians as intended.

For more information about the exclusion of the Simple Pneumonia with Hospitalization measure, please see the 2023 MIPS Cost Measure Exclusion Fact Sheet (PDF, 190KB) [ https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2855/2023-mips-cost-measure-exclusion-factsheet.pdf ].

*Additional Resources – 2023 MIPS performance period/2025 MIPS payment year*

Additional information about the cost measures that will be calculated and reported under the cost performance category, as well as the Simple Pneumonia with Hospitalization measure, is available here:__


* 2023 MIPS Cost Measure Information Forms [ https://qpp.cms.gov/resources/document/d3155732-11f0-4088-9dd5-0ce5cbbe30b4 ]
* 2023 MIPS Cost Measure Codes Lists [ https://qpp.cms.gov/resources/document/d56b4956-0207-4c17-ba16-04381b4ee861 ]

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QPP Footer 2023 [ https://qpp.cms.gov/resources/help-and-support ]


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