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  • MIPS 2022—Cost: Total Per Capita Cost Measure

    This content is excerpted from EyeNet’s MIPS 2022: A Primer and Reference; also see the Academy’s MIPS hub page.

    This measure tries to allocate all of a patient’s Medicare Part A and Part B costs to a primary care clinician. However, if the pa­tient doesn’t see such a clinician, he or she could be attributed to a non–primary care clinician.

    Ophthalmologists and optometrists are excluded from the TPCC measure. In years gone by, some ophthalmolo­gists were scored on the TPCC measure, and some eye care practices decided to bill Eye visit codes rather than Evalua­tion and Management (E/M) codes in order to avoid meeting the 20-patient case minimum for this measure. Since 2020, ophthalmologists and optometrists are excluded from this measure based on their two-digit specialty identifier in the Provider Enrollment, Chain, and Ownership System, better known as PECOS.

    Caveat. Suppose you are in a multispecialty practice and you have colleagues who aren’t excluded from the TPCC measure; if the practice reports as a group, the group may be scored on this measure.

    What if you aren’t excluded? If the above caveat doesn’t apply to you but you are still scored on this measure, please contact the Academy at

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