2022 MIPS Melanoma Resection Cost Measure

There are several new MIPS Cost measures in 2022, including the new Melanoma Resection episode-based Cost measure. A quick summary of this new measure is that it evaluates Medicare Part A and B costs related to the removal and tissue repair of cutaneous (including eyelid) malignant melanoma, except in cases in which Mohs surgery is used.

For more information about the new Melanoma Resection Cost measure, continue reading.

Who Will Be Scored on the Melanoma Resection Cost Measure?

To receive a score on this measure, a clinician (if reporting MIPS at the individual level) or group (if reporting MIPS at the group level) must perform at least 10 cutaneous melanoma resections or tissue transfer repair during the calendar year. Episodes that include Mohs surgery do not count toward this 10 episode case minimum.

Which Cases Will Be Included?

This measure is triggered when a CPT code for removal of malignant growth or tissue transfer repair of wound is billed combined with the ICD-10 for either malignant melanoma (C43) or melanoma in situ (D03).

Any episodes that include Mohs surgery at any time during the episode window are excluded from the measure.

If you would like to review the CMS source material, here is the official CMS Melanoma Resection Cost measure specification and the Melanoma Resection code list.

What Costs Are Included?

When an episode is triggered, CMS opens a cost episode window which, for the Melanoma Resection Cost measure, goes from 30 days prior to the trigger to 90 days after the trigger. Costs related to melanoma resection that are billed by the NPI (if reporting MIPS as an individual) or the TIN (if reporting MIPS at the group level) during the cost episode window are included.

This includes costs for claims in which the first diagnosis is melanoma (e.g., office visits, telehealth, ED visits, home health, anesthesia, surgery, medications, etc.).

How is the Melanoma Resection Cost Measure Scored?

Cost episode measures are scored by comparing a clinician’s or group’s observed episode costs to an expected cost that is based on national administrative claims data. To limit the impact of variables outside of clinician control, CMS splits the eligible episodes for this measure into two groups (head/neck and trunk/extremity) and takes a weighted average of a clinician’s or group’s scores in these subgroups to determine their measure score.

Next Steps

  • Share this information with your colleagues.
  • If you are a MarsdenAdvisors client
    • Keep an eye out for an email containing your pre-kickoff call 2022 MIPS overview. This is a recorded presentation we put together to ensure that you get the most out of your 2022 kickoff. This has additional details on the Melanoma Resection Cost measure to help you succeed.
    • Schedule your 2022 kickoff call.
  • If you are not a MarsdenAdvisors client
    • Contact us to learn more about our MIPS Success Plan and to reap the rewards of our combined decades of experience.

If you have any questions on this, let us know!

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