Cost (30%)

Unlike the other MIPS categories, dermatologists and other eligible clinicians do not have to actively report data for the cost category. Instead, CMS automatically calculates the clinician’s performance score using information from claims data.

If dermatologists perform 10 or more melanoma resections that meet the eligibility criteria for this measure, CMS will automatically apply these to the cost category and assign a score up to 30% of the overall MIPS score. If an eligible clinician does not perform 10 or more melanoma resections in the performance year, they will automatically be exempt from the cost measure, and the weight of this category will be redistributed to other categories.

In more formal terms, the Melanoma Resection cost measure evaluates your risk-adjusted cost of Medicare patients who undergo an excision procedure to remove a cutaneous melanoma by comparing your score to other eligible clinicians. Medicare beneficiaries enrolled in Medicare Parts A and B during the performance period are included in the measure calculation.

The measure applies to both the procedure itself and to all services that are clinically related to the procedure under the reasonable influence of the eligible clinician, within the episode window. The episode window is from 30 days before the melanoma resection procedure until 90 days after the procedure.

The measure is only for melanoma resection, not for treatment of advanced metastatic disease. For instance, the measure does not include any costs of chemotherapy or immunotherapy services.

How the measure is calculated

The numerator for the measure is the sum of the ratio of observed to expected payment-standardized cost to Medicare for all Melanoma Resection episodes attributed to the eligible clinician. This sum is then multiplied by the national average observed episode cost to generate a dollar figure.

Mathematically, this is represented as: sum of (observed episode cost/expected episode cost) x national average observed cost.

The denominator for the Melanoma Resection measure is the total number of episodes from this episode group attributed to the clinician.

Additional MIPS scoring information