QPP Measure #COST_STEMI_1
Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized Medicare allowed amount, and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Inpatient PCI episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for patients who present with a cardiac event and emergently receive PCI as treatment during the performance period. The measure score is the clinician’s risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician. This acute inpatient medical condition measure includes costs of services that are clinically related to the attributed clinician’s role in managing care during each episode from the clinical event that opens, or “triggers,” the episode through 30 days after the trigger.
The following codes apply for this QPP measure:
HCPCS Codes | |||
| Code | Description | ||
|---|---|---|---|
| G0055 | Advancing care for heart disease mips value pathways | ||
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