{"data":{"id":"us/42-cfr-414.1205","jurisdiction":"us","citation":"42 CFR 414.1205","heading":"Definitions.","body":"As used in this subpart, unless otherwise indicated—\nAccountable care organization (ACO) has the same meaning given this term under § 425.20 of this chapter.\nCertified registered nurse anesthetist (CRNA) has the same meaning given this term under section 1861(bb)(2) of the Act.\nCritical access hospital has the same meaning given this term under § 400.202 of this chapter.\nElectronic health record (EHR) has the same meaning given this term under § 414.92 of this chapter.\nEligible professional has the same meaning given this term under section 1848(k)(3)(B) of the Act.\nFederally Qualified Health Center has the same meaning given this term under § 405.2401(b) of this chapter.\nGroup of physicians (Group) means a single Taxpayer Identification Number (TIN) with 2 or more eligible professionals, as identified by their individual National Provider Identifier (NPI), who have reassigned their Medicare billing rights to the TIN.\nPerformance period means the calendar year that will be used to assess the quality of care furnished compared to cost.\nPerformance rate mean the calculated rate for each quality or cost measure such as the percent of times that a particular clinical quality action was reported as being performed, or a particular outcome was attained, for the applicable persons to whom a measure applies as described in the denominator for the measure.\nPhysician has the same meaning given this term under section 1861(r) of the Act.\nPhysician assistant (PA), nurse practitioner (NP), and clinical nurse specialist (CNS) have the same meanings given these terms under section 1861(aa)(5) of the Act.\nPhysician Fee Schedule has the same meaning given this term under part 410 of this chapter.\nPhysician Quality Reporting System means the system established under section 1848(k) of the Act.\nRisk score means the beneficiary risk score derived from the CMS Hierarchical Condition Categories (HCC) model.\nSolo practitioner means a single Taxpayer Identification Number (TIN) with one eligible professional who is identified by an individual National Provider Identifier (NPI) billing under the TIN.\nTaxpayer Identification Number (TIN) has the same meaning given this term under § 425.20 of this chapter.\nValue-based payment modifier means the percentage as determined under § 414.1270 by which amounts paid to a group or solo practitioner under the Medicare Physician Fee Schedule established under section 1848 of the Act are adjusted based upon a comparison of the quality of care furnished to cost as determined by this subpart.","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":"713e38c06ca9cf9bf98d047c83466a011a2c9b625d1d2c4172301225afc1b6fc","source_id":"us-cfr","stale":true,"prev":"us/42-cfr-414.1200","next":"us/42-cfr-414.1210"},"notice":"GroundRules: Original legal text. Not legal advice."}