PQRS Measure
Report via: Claim, Registry, EHR, GPRO/ACO, Measure Group
This measure is can be reported as part of the following groups:
• Preventive Care Group
• Heart Failure (HF) Group
• Coronary Artery Disease (CAD) Group
• Ischemic Vascular Disease (IVD) Group
• Chronic Obstructive Pulmonary Disease (COPD) Group
• Inflammatory Bowel Disease (IBD) Group
• Cardiovascular Prevention Group
• Oncology Group
• Preventive Care Group
• Heart Failure (HF) Group
• Coronary Artery Disease (CAD) Group
• Ischemic Vascular Disease (IVD) Group
• Chronic Obstructive Pulmonary Disease (COPD) Group
• Inflammatory Bowel Disease (IBD) Group
• Cardiovascular Prevention Group
• Oncology 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 |
| 90845 | N/A | N/A | Psychoanalysis |
| 92002 | N/A | N/A | Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient |
| 92004 | N/A | N/A | Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits |
| 92012 | N/A | N/A | Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient |
| 92014 | N/A | N/A | Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits |
| 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 |
| 97003 | N/A | N/A | Occupational therapy evaluation |
| 97004 | N/A | N/A | Occupational therapy re-evaluation |
| 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. |
| 99406 | N/A | N/A | Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes |
| 99407 | N/A | N/A | Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes |
| 1036F | N/A | N/A | Current tobacco non-user (CAD, CAP, COPD, PV) (DM) (IBD) |
| 1036F | N/A | N/A | Current tobacco non-user (CAD, CAP, COPD, PV) (DM) (IBD) |
| 4004F | 8P | N/A | Patient screened for tobacco use and received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user (PV, CAD) |
| 4004F | N/A | N/A | Patient screened for tobacco use and received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user (PV, CAD) |
| 4004F | 1P | N/A | Patient screened for tobacco use and received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user (PV, CAD) |
| 4004F | N/A | N/A | Patient screened for tobacco use and received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user (PV, CAD) |
| 4004F | 8P | N/A | Patient screened for tobacco use and received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user (PV, CAD) |
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| 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 |
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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