---
kind: "section"
citation: "42 C.F.R. § 414.1200"
title: "42"
number: "414.1200"
heading: "Basis and scope."
url: "https://uscodex.org/cfr/42/414.1200"
---

# §414.1200. Basis and scope.

- (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.
- (b) **Scope.** This subpart sets forth the following:
  - (1) **The application of the value-based payment modifier.**
  - (2) **Performance and payment adjustment periods.**
  - (3) **Reporting mechanisms for the value-based payment modifier.**
  - (4) Alignment of PQRS quality of care measures with the quality measures for the value-based payment modifier.
  - (5) **Additional measures for groups and solo practitioners.**
  - (6) **Cost measures.**
  - (7) **Attribution for quality of care and cost measures.**
  - (8) **Scoring methods for the value-based payment modifier.**
  - (9) **Benchmarks for quality of care measures.**
  - (10) **Benchmarks for cost measures.**
  - (11) **Composite scores.**
  - (12) **Reliability of measures.**
  - (13) **Payment adjustments.**
  - (14) **Value-based payment modifier quality-tiering scoring methodology.**
  - (15) **Limitation of review.**
  - (16) **Inquiry process.**

## Notes

### Amendments

[77 FR 69368, Nov. 16, 2012, as amended at 79 FR 68005, Nov. 13, 2014]

### Source

Source: 77 FR 69368, Nov. 16, 2012, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302, 1395hh, and 1395rr(b)(l).

### Source

Source: 55 FR 23441, June 8, 1990, unless otherwise noted.

### Amendments

[77 FR 69368, Nov. 16, 2012, as amended at 79 FR 68005, Nov. 13, 2014]