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42 CFR § 414.1205 - Definitions.

---
identifier: "/us/cfr/t42/s414.1205"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 414.1205 - Definitions."
title_number: 42
title_name: "Public Health"
section_number: "414.1205"
section_name: "Definitions."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "B"
subchapter_name: "MEDICARE PROGRAM"
part_number: "414"
part_name: "PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES"
positive_law: false
currency: "2026-03-24"
last_updated: "2026-03-24"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302, 1395hh, and 1395rr(b)(l)."
regulatory_source: "55 FR 23441, June 8, 1990, unless otherwise noted."
cfr_part: "414"
---

# 414.1205 Definitions.

As used in this subpart, unless otherwise indicated—

*Accountable care organization* (ACO) has the same meaning given this term under § 425.20 of this chapter.

*Certified registered nurse anesthetist (CRNA)* has the same meaning given this term under section 1861(bb)(2) of the Act.

*Critical access hospital* has the same meaning given this term under § 400.202 of this chapter.

*Electronic health record* (EHR) has the same meaning given this term under § 414.92 of this chapter.

*Eligible professional* has the same meaning given this term under section 1848(k)(3)(B) of the Act.

*Federally Qualified Health Center* has the same meaning given this term under § 405.2401(b) of this chapter.

*Group 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.

*Performance period* means the calendar year that will be used to assess the quality of care furnished compared to cost.

*Performance 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.

*Physician* has the same meaning given this term under section 1861(r) of the Act.

*Physician 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.

*Physician Fee Schedule* has the same meaning given this term under part 410 of this chapter.

*Physician Quality Reporting System* means the system established under section 1848(k) of the Act.

*Risk score* means the beneficiary risk score derived from the CMS Hierarchical Condition Categories (HCC) model.

*Solo 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.

*Taxpayer Identification Number* (TIN) has the same meaning given this term under § 425.20 of this chapter.

*Value-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.

[77 FR 69368, Nov. 16, 2012, as amended at 79 FR 68005, Nov. 13, 2014; 80 FR 71382, Nov. 16, 2015]