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doi: 10.1080/20008198.2020.1863579 11 MaerckerACloitreMBachemRSchlumpfYRKhouryBHitchcockCet al

For each drug or biological that is identified in accordance with paragraph (a) of this section, CMS will calculate average total allowed charges for a year per individual as follows: (i) For single source drugs and biological products assigned to only one billing and payment code, CMS will sum the allowed charges from final action claims greater than $0 and divide the summed amount by the number of ( individuals who use such a drug or biological with allowed charges for this billing and payment code

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For a group of 15 or fewer clinicians, participation at the group or subgroup level for MVP ( reporting would provide similar performance information to clinicians and patients