PQRS Measure
Report via: Claim, Registry, Measure Group
This measure is can be reported as part of the following groups:
• Rheumatoid Arthritis Group
• Sinusitis Group
• Acute Otitis Externa (AOE) Group
• Multiple Chronic Conditions Group
• Rheumatoid Arthritis Group
• Sinusitis Group
• Acute Otitis Externa (AOE) Group
• Multiple Chronic Conditions Group
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 90791 | Psychiatric diagnostic evaluation | ||
| 90792 | Psychiatric diagnostic evaluation with medical services | ||
| 92002 | Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient | ||
| 92004 | Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits | ||
| 92012 | Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient | ||
| 92014 | Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits | ||
| 92507 | Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual | ||
| 92508 | Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals | ||
| 92526 | Treatment of swallowing dysfunction and/or oral function for feeding | ||
| 96116 | Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour | ||
| 96118 | Neuropsychological testing (eg, Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), per hour of the psychologist's or physician's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report | ||
| 96150 | 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 | 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 | ||
| 97001 | Physical therapy evaluation | ||
| 97002 | Physical therapy re-evaluation | ||
| 97003 | Occupational therapy evaluation | ||
| 97004 | Occupational therapy re-evaluation | ||
| 97532 | Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes | ||
| 98940 | Chiropractic manipulative treatment (CMT); spinal, 1-2 regions | ||
| 98941 | Chiropractic manipulative treatment (CMT); spinal, 3-4 regions | ||
| 98942 | Chiropractic manipulative treatment (CMT); spinal, 5 regions | ||
| 99201 | 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 | 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 | 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 | 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 | 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 | 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 | 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 | 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 | 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 | |||
| D7210 | |||
| G0101 | Cervical or vaginal cancer screening; pelvic and clinical breast examination | ||
| G0402 | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment | ||
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | ||
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | ||
| G8442 | Pain assessment not documented as being performed, documentation the patient is not eligible for a pain assessment using a standardized tool at the time of the encounter | ||
| G8509 | Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given | ||
| G8509 | Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given | ||
| G8730 | Pain assessment documented as positive using a standardized tool and a follow-up plan is documented | ||
| G8730 | Pain assessment documented as positive using a standardized tool and a follow-up plan is documented | ||
| G8731 | Pain assessment using a standardized tool is documented as negative, no follow-up plan required | ||
| G8731 | Pain assessment using a standardized tool is documented as negative, no follow-up plan required | ||
| G8732 | No documentation of pain assessment, reason not given | ||
| G8732 | No documentation of pain assessment, reason not given | ||
| G8939 | Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible at the time of the encounter | ||
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.
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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