---
kind: "section"
citation: "42 C.F.R. § 414.1265"
title: "42"
number: "414.1265"
heading: "Reliability of measures."
url: "https://uscodex.org/cfr/42/414.1265"
---

# §414.1265. Reliability of measures.


To calculate a composite score for a quality measure or a cost measure, a group or solo practitioner subject to the value-based payment modifier must have 20 or more cases for that measure.

- (a) In a performance period, if a group or solo practitioner has fewer than 20 cases for a measure, that measure is excluded from its domain and the remaining measures in the domain are given equal weight.
  - (1) Starting with the CY 2017 payment adjustment period, the exception to this [paragraph (a)](#a) is the all-cause hospital readmissions measure described at [§ 414.1230(c)](/cfr/42/414.1230.md?p=c). In a performance period, if a group has fewer than 200 cases for this all-cause hospital readmissions measure, that measure is excluded from its domain and the remaining measures in the domain are given equal weight.
  - (2) Starting with the CY 2017 payment adjustment period, the Medicare Spending Per Beneficiary measure described at [§ 414.1235(a)(6)](/cfr/42/414.1235.md?p=a-6) is an exception to this [paragraph (a)](#a). In a performance period, if a group or a solo practitioner has fewer than 125 episodes for this MSPB measure, that measure is excluded from its domain and the remaining measures in the domain are given equal weight.
- (b)
  - (1) For the CY 2015 payment adjustment period, if a reliable quality of care composite or cost composite cannot be calculated, payments will not be adjusted under the value-based payment modifier.
  - (2) Beginning with the CY 2016 payment adjustment period, a group and a solo practitioner subject to the value-based payment modifier will receive a quality composite score that is classified as “average” under [§ 414.1275(b)(1)](/cfr/42/414.1275.md?p=b-1) if such group and solo practitioner do not have at least one quality measure that meets the minimum number of cases under [paragraph (a)](#a) of this section.
  - (3) Beginning with the CY 2016 payment adjustment period, a group and a solo practitioner subject to the value-based payment modifier will receive a cost composite score that is classified as “average” under [§ 414.1275(b)(2)](/cfr/42/414.1275.md?p=b-2) if such group and solo practitioner do not have at least one cost measure that meets the minimum number of cases under [paragraph (a)](#a) of this section.

## Notes

### Amendments

[77 FR 69368, Nov. 16, 2012, as amended at 79 FR 68007, Nov. 13, 2014; 80 FR 71384, Nov. 16, 2015]

### 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 68007, Nov. 13, 2014; 80 FR 71384, Nov. 16, 2015]