PQRS Measure
Report via: Claim, Registry, EHR, GPRO/ACO, Measure Group
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 90791 | N/A | N/A | Psychiatric diagnostic evaluation |
| 90792 | N/A | N/A | Psychiatric diagnostic evaluation with medical services |
| 90832 | N/A | N/A | Psychotherapy, 30 minutes with patient |
| 90834 | N/A | N/A | Psychotherapy, 45 minutes with patient |
| 90837 | N/A | N/A | Psychotherapy, 60 minutes with patient |
| 90839 | N/A | N/A | Psychotherapy for crisis; first 60 minutes |
| 96150 | N/A | N/A | Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; initial assessment |
| 96151 | N/A | N/A | Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; re-assessment |
| 96152 | N/A | N/A | Health and behavior intervention, each 15 minutes, face-to-face; individual |
| 97001 | N/A | N/A | Physical therapy evaluation |
| 97003 | N/A | N/A | Occupational therapy evaluation |
| 97802 | N/A | N/A | Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes |
| 97803 | N/A | N/A | Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes |
| 98960 | N/A | N/A | Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient |
| 99201 | N/A | N/A | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. |
| 99202 | N/A | N/A | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. |
| 99203 | N/A | N/A | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. |
| 99204 | N/A | N/A | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. |
| 99205 | N/A | N/A | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. |
| 99212 | N/A | N/A | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. |
| 99213 | N/A | N/A | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. |
| 99214 | N/A | N/A | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. |
| 99215 | N/A | N/A | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. |
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| D7140 | N/A | N/A | |
| D7210 | N/A | N/A | |
| G0101 | N/A | N/A | Cervical or vaginal cancer screening; pelvic and clinical breast examination |
| G0108 | N/A | N/A | Diabetes outpatient self-management training services, individual, per 30 minutes |
| G0270 | N/A | N/A | Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes |
| G0271 | N/A | N/A | Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes |
| G0402 | N/A | N/A | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment |
| G0438 | N/A | N/A | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit |
| G0439 | N/A | N/A | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
| G0447 | N/A | N/A | Face-to-face behavioral counseling for obesity, 15 minutes |
| G8417 | N/A | N/A | Bmi is documented above normal parameters and a follow-up plan is documented |
| G8417 | N/A | N/A | Bmi is documented above normal parameters and a follow-up plan is documented |
| G8418 | N/A | N/A | Bmi is documented below normal parameters and a follow-up plan is documented |
| G8418 | N/A | N/A | Bmi is documented below normal parameters and a follow-up plan is documented |
| G8419 | N/A | N/A | Bmi documented outside normal parameters, no follow-up plan documented, no reason given |
| G8419 | N/A | N/A | Bmi documented outside normal parameters, no follow-up plan documented, no reason given |
| G8420 | N/A | N/A | Bmi is documented within normal parameters and no follow-up plan is required |
| G8420 | N/A | N/A | Bmi is documented within normal parameters and no follow-up plan is required |
| G8421 | N/A | N/A | Bmi not documented and no reason is given |
| G8421 | N/A | N/A | Bmi not documented and no reason is given |
| G8422 | N/A | N/A | Bmi not documented, documentation the patient is not eligible for bmi calculation |
| G8938 | N/A | N/A | Bmi is documented as being outside of normal parameters, follow-up plan is not documented, documentation the patient is not eligible |
Legend:
ClaimThis measure can be submitted via claim. Use the 'Data Collection' pdf associated with the measure.
GroupThis measure can be submitted through one or more groups. Click on the group name to view the group information.
RegistryThis measure can be submitted through registry.
EHRThis measure can be submitted via Electronic Health Record (EHR).
GPRO/ACOThis measure can be submitted via Group Practice Reporting Option, or GPRO Web Interface.
SurveyThis measure can be submitted/collected via a Certified Survey Vendor.
More information on these alternative reporting mechanisms is available at:
http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.
ClaimThis measure can be submitted via claim. Use the 'Data Collection' pdf associated with the measure.
GroupThis measure can be submitted through one or more groups. Click on the group name to view the group information.
RegistryThis measure can be submitted through registry.
EHRThis measure can be submitted via Electronic Health Record (EHR).
GPRO/ACOThis measure can be submitted via Group Practice Reporting Option, or GPRO Web Interface.
SurveyThis measure can be submitted/collected via a Certified Survey Vendor.
More information on these alternative reporting mechanisms is available at:
http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.
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