Physical therapists became eligible to participate for the first time in the Cost performance category of the Merit-Based Incentive Payment System, or MIPS, in 2024. For those for whom participation is not mandatory, the March 31 decision deadline is approaching for many PTs and practices to determine if they want to participate voluntarily for the 2024 reporting year.
Read more about the reporting requirements for the Cost category.
Here are a few things to keep in mind when making this voluntary determination:
No feedback from CMS. As a reminder, providers do not need to submit data for this category; CMS calculates the Cost score based on performance year benchmarks gleaned from claims data across the full calendar year. General guidance on maximizing Cost scores has long been available, but specific feedback on a practice’s 2024 performance from the Centers for Medicare & Medicaid Services won't be released until this summer — after the March 31 determination deadline. Because PTs have not participated in the Cost category before, they don’t have past years' data or CSM feedback to use for estimating their performance in 2024.
Low back pain measure. This is the only measure available to PTs in the Cost category right now, so all scoring is based on qualified patients treated for LBP. It is a chronic-condition episode-based cost measure, which means it assesses costs clinically related to the care and management of patients with LBP provided during a total attribution window divided into episodes. Scroll down to "Current Cost Measures Impacting Physical Therapists" on our Cost category webpage to learn more about the LBP cost measure.
Case minimum exemption. If your practice doesn't meet the case minimum for the Low Back Pain Cost Measure, then you aren't accountable for the category, and the 30% weighting will be applied to a different category, most likely Quality performance. The minimum case requirement is 20 episodes within the calendar year.
For more about MIPS or the Cost performance category:
CMS MIPS 2024 Cost Performance Category Quick Guide
APTA’s Merit-Based Incentive Program webpage
Members with questions can contact APTA Advocacy.