{"data":{"id":"us/42-cfr-414.1200","jurisdiction":"us","citation":"42 CFR 414.1200","heading":"Basis and scope.","body":"(a) Basis. This subpart implements section 1848(p) of the Act by establishing a payment modifier that provides for differential payment starting in 2015 to a group of physicians and starting in 2017 to a group and a solo practitioner under the Medicare Physician Fee Schedule based on the quality of care furnished compared to cost during a performance period.\n(b) Scope. This subpart sets forth the following:\n(1) The application of the value-based payment modifier.\n(2) Performance and payment adjustment periods.\n(3) Reporting mechanisms for the value-based payment modifier.\n(4) Alignment of PQRS quality of care measures with the quality measures for the value-based payment modifier.\n(5) Additional measures for groups and solo practitioners.\n(6) Cost measures.\n(7) Attribution for quality of care and cost measures.\n(8) Scoring methods for the value-based payment modifier.\n(9) Benchmarks for quality of care measures.\n(10) Benchmarks for cost measures.\n(11) Composite scores.\n(12) Reliability of measures.\n(13) Payment adjustments.\n(14) Value-based payment modifier quality-tiering scoring methodology.\n(15) Limitation of review.\n(16) Inquiry process.","path":["Title 42—Public Health","CHAPTER IV—CENTERS FOR MEDICARE \u0026 MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES","SUBCHAPTER B—MEDICARE PROGRAM","PART 414—PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES","Subpart N—Value-Based Payment Modifier Under the Physician Fee Schedule"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-42.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:11Z","sha256":"aff585d057f4834c4904dc34d9c82b6577b5789bd92626f5c5904ebc578e6725","source_id":"us-cfr","stale":true,"prev":"us/42-cfr-414.1105","next":"us/42-cfr-414.1205"},"notice":"GroundRules: Original legal text. Not legal advice."}