Year:  2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 

PQRS Measure

#128Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
 Report via: Claim, Registry, EHR, GPRO/ACO, Measure Group
 This measure is can be reported as part of the following groups:
 • Preventive Care Group   
 • Rheumatoid Arthritis Group   
 • Coronary Artery Disease (CAD) Group   
 • Asthma Group   
 • Sleep Apnea Group   
 • Multiple Chronic Conditions Group   

The following codes apply for this PQRS measure:

CPT Codes

CodeModifierPOSDescription
90791Psychiatric diagnostic evaluation
90792Psychiatric diagnostic evaluation with medical services
90832Psychotherapy, 30 minutes with patient
90834Psychotherapy, 45 minutes with patient
90837Psychotherapy, 60 minutes with patient
90839Psychotherapy for crisis; first 60 minutes
96150Health 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
96151Health 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
96152Health and behavior intervention, each 15 minutes, face-to-face; individual
97001Physical therapy evaluation
97003Occupational therapy evaluation
97802Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes
97803Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
98960Education 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
99201Office 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.
99202Office 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.
99203Office 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.
99204Office 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.
99205Office 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.
99212Office 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.
99213Office 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.
99214Office 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.
99215Office 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

CodeModifierPOSDescription
D7140
D7210
G0101Cervical or vaginal cancer screening; pelvic and clinical breast examination
G0108Diabetes outpatient self-management training services, individual, per 30 minutes
G0270Medical 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
G0271Medical 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
G0402Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
G0438Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
G0447Face-to-face behavioral counseling for obesity, 15 minutes
G8417Bmi is documented above normal parameters and a follow-up plan is documented
G8417Bmi is documented above normal parameters and a follow-up plan is documented
G8418Bmi is documented below normal parameters and a follow-up plan is documented
G8418Bmi is documented below normal parameters and a follow-up plan is documented
G8419Bmi documented outside normal parameters, no follow-up plan documented, no reason given
G8419Bmi documented outside normal parameters, no follow-up plan documented, no reason given
G8420Bmi is documented within normal parameters and no follow-up plan is required
G8420Bmi is documented within normal parameters and no follow-up plan is required
G8421Bmi not documented and no reason is given
G8421Bmi not documented and no reason is given
G8422Bmi not documented, documentation the patient is not eligible for bmi calculation
G8938Bmi 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).
GPROThis 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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