PQRS Measure
This measure may be submitted via Registry only
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 90785 | Interactive complexity (List separately in addition to the code for primary procedure) | ||
| 90791 | Psychiatric diagnostic evaluation | ||
| 90792 | Psychiatric diagnostic evaluation with medical services | ||
| 90832 | Psychotherapy, 30 minutes with patient | ||
| 90833 | Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | ||
| 90834 | Psychotherapy, 45 minutes with patient | ||
| 90836 | Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | ||
| 90837 | Psychotherapy, 60 minutes with patient | ||
| 90838 | Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | ||
| 98960 | 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 | ||
| 98961 | 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; 2-4 patients | ||
| 98962 | 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; 5-8 patients | ||
| 99078 | Physician or other qualified health care professional qualified by education, training, licensure/regulation (when applicable) educational services rendered to patients in a group setting (eg, prenatal, obesity, or diabetic instructions) | ||
| 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. | ||
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional | ||
| 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. | ||
| 99217 | Observation care discharge day management (This code is to be utilized to report all services provided to a patient on discharge from outpatient hospital "observation status" if the discharge is on other than the initial date of "observation status." To report services to a patient designated as "observation status" or "inpatient status" and discharged on the same date, use the codes for Observation or Inpatient Care Services [including Admission and Discharge Services, 99234-99236 as appropriate.]) | ||
| 99218 | Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. 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 problem(s) requiring admission to outpatient hospital "observation status" are of low severity. Typically, 30 minutes are spent at the bedside and on the patient's hospital floor or unit. | ||
| 99219 | Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. 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 problem(s) requiring admission to outpatient hospital "observation status" are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient's hospital floor or unit. | ||
| 99220 | Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. 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 problem(s) requiring admission to outpatient hospital "observation status" are of high severity. Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit. | ||
| 99224 | Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity. 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 patient is stable, recovering, or improving. Typically, 15 minutes are spent at the bedside and on the patient's hospital floor or unit. | ||
| 99225 | Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. 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 patient is responding inadequately to therapy or has developed a minor complication. Typically, 25 minutes are spent at the bedside and on the patient's hospital floor or unit. | ||
| 99226 | Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. 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 patient is unstable or has developed a significant complication or a significant new problem. Typically, 35 minutes are spent at the bedside and on the patient's hospital floor or unit. | ||
| 99281 | Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional | ||
| 99282 | Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making | ||
| 99283 | Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making | ||
| 99284 | Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making | ||
| 99285 | Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making | ||
| 99304 | Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded. | ||
| 99305 | Initial nursing facility care, per day, for the evaluation and management of a 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, 35 minutes must be met or exceeded. | ||
| 99306 | Initial nursing facility care, per day, for the evaluation and management of a 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, 50 minutes must be met or exceeded. | ||
| 99307 | Subsequent nursing facility care, per day, for the evaluation and management of a 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. | ||
| 99308 | Subsequent nursing facility care, per day, for the evaluation and management of a 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. | ||
| 99309 | Subsequent nursing facility care, per day, for the evaluation and management of a 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. | ||
| 99310 | Subsequent nursing facility care, per day, for the evaluation and management of a 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, 45 minutes must be met or exceeded. | ||
| 99315 | Nursing facility discharge management; 30 minutes or less total time on the date of the encounter | ||
| 99316 | Nursing facility discharge management; more than 30 minutes total time on the date of the encounter | ||
| 99318 | Evaluation and management of a patient involving an annual nursing facility assessment, which requires these 3 key components: A detailed interval history; A comprehensive examination; and Medical decision making that is of low to moderate complexity. 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 patient is stable, recovering, or improving. Typically, 30 minutes are spent at the bedside and on the patient's facility floor or unit. | ||
| 99324 | Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and 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 of low severity. Typically, 20 minutes are spent with the patient and/or family or caregiver. | ||
| 99325 | Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. 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 of moderate severity. Typically, 30 minutes are spent with the patient and/or family or caregiver. | ||
| 99326 | Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. 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 of moderate to high severity. Typically, 45 minutes are spent with the patient and/or family or caregiver. | ||
| 99327 | Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. 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 of high severity. Typically, 60 minutes are spent with the patient and/or family or caregiver. | ||
| 99328 | Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. 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 patient is unstable or has developed a significant new problem requiring immediate physician attention. Typically, 75 minutes are spent with the patient and/or family or caregiver. | ||
| 99334 | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval 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, 15 minutes are spent with the patient and/or family or caregiver. | ||
| 99335 | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. 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 of low to moderate severity. Typically, 25 minutes are spent with the patient and/or family or caregiver. | ||
| 99336 | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. 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 of moderate to high severity. Typically, 40 minutes are spent with the patient and/or family or caregiver. | ||
| 99337 | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. 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 of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent with the patient and/or family or caregiver. | ||
| 99341 | Home or residence 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. | ||
| 99342 | Home or residence 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. | ||
| 99343 | Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. 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 of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family. | ||
| 99344 | Home or residence 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, 60 minutes must be met or exceeded. | ||
| 99345 | Home or residence 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, 75 minutes must be met or exceeded. | ||
| 99347 | Home or residence 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, 20 minutes must be met or exceeded. | ||
| 99348 | Home or residence 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, 30 minutes must be met or exceeded. | ||
| 99349 | Home or residence 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, 40 minutes must be met or exceeded. | ||
| 99350 | Home or residence 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, 60 minutes must be met or exceeded. | ||
| 99385 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years | ||
| 99386 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years | ||
| 99387 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older | ||
| 99395 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years | ||
| 99396 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years | ||
| 99397 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older | ||
| 99401 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes | ||
| 99402 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes | ||
| 99403 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes | ||
| 99404 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes | ||
| 99411 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes | ||
| 99412 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes | ||
| 99429 | Unlisted preventive medicine service | ||
| 90845 | 03, 0 | Psychoanalysis | |
| 90847 | 03, 0 | Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes | |
| 90849 | 03, 0 | Multiple-family group psychotherapy | |
| 90853 | 03, 0 | Group psychotherapy (other than of a multiple-family group) | |
| 90862 | 03, 0 | Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy | |
| 90870 | 03, 0 | Electroconvulsive therapy (includes necessary monitoring) | |
| 90875 | 03, 0 | Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 30 minutes | |
| 90876 | 03, 0 | Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 45 minutes | |
| 90880 | 03, 0 | Hypnotherapy | |
| 99291 | 03, 0 | Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes | |
| 99292 | 03, 0 | Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service) | |
| 90791 | 23, 3 | Psychiatric diagnostic evaluation | |
| 90792 | 23, 3 | Psychiatric diagnostic evaluation with medical services | |
| 90832 | 23, 3 | Psychotherapy, 30 minutes with patient | |
| 90833 | 23, 3 | Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | |
| 90834 | 23, 3 | Psychotherapy, 45 minutes with patient | |
| 90836 | 23, 3 | Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | |
| 90837 | 23, 3 | Psychotherapy, 60 minutes with patient | |
| 90838 | 23, 3 | Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | |
| 90845 | 23, 3 | Psychoanalysis | |
| 90847 | 23, 3 | Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes | |
| 90849 | 23, 3 | Multiple-family group psychotherapy | |
| 90853 | 23, 3 | Group psychotherapy (other than of a multiple-family group) | |
| 90862 | 23, 3 | Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy | |
| 90870 | 23, 3 | Electroconvulsive therapy (includes necessary monitoring) | |
| 90875 | 23, 3 | Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 30 minutes | |
| 90876 | 23, 3 | Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 45 minutes | |
| 99291 | 23, 3 | Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes | |
| 99292 | 23, 3 | Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service) | |
| 90791 | 21, 5 | Psychiatric diagnostic evaluation | |
| 90792 | 21, 5 | Psychiatric diagnostic evaluation with medical services | |
| 90832 | 21, 5 | Psychotherapy, 30 minutes with patient | |
| 90833 | 21, 5 | Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | |
| 90834 | 21, 5 | Psychotherapy, 45 minutes with patient | |
| 90837 | 21, 5 | Psychotherapy, 60 minutes with patient | |
| 90838 | 21, 5 | Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | |
| 90845 | 21, 5 | Psychoanalysis | |
| 90847 | 21, 5 | Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes | |
| 90849 | 21, 5 | Multiple-family group psychotherapy | |
| 90853 | 21, 5 | Group psychotherapy (other than of a multiple-family group) | |
| 90862 | 21, 5 | Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy | |
| 90870 | 21, 5 | Electroconvulsive therapy (includes necessary monitoring) | |
| 90875 | 21, 5 | Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 30 minutes | |
| 90876 | 21, 5 | Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 45 minutes | |
| 99221 | 21, 5 | Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. | |
| 99222 | 21, 5 | Initial hospital inpatient or observation care, per day, for the evaluation and management of a 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, 55 minutes must be met or exceeded. | |
| 99223 | 21, 5 | Initial hospital inpatient or observation care, per day, for the evaluation and management of a 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, 75 minutes must be met or exceeded. | |
| 99231 | 21, 5 | Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded. | |
| 99232 | 21, 5 | Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a 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, 35 minutes must be met or exceeded. | |
| 99233 | 21, 5 | Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a 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, 50 minutes must be met or exceeded. | |
| 99238 | 21, 5 | Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter | |
| 99239 | 21, 5 | Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter | |
| 99291 | 21, 5 | Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes | |
| 99292 | 21, 5 | Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service) | |
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| G0155 | Services of clinical social worker in home health or hospice settings, each 15 minutes | ||
| G0176 | Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) | ||
| G0177 | Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more) | ||
| G0409 | Social work and psychological services, directly relating to and/or furthering the patient's rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a corf-qualified social worker or psychologist in a corf) | ||
| G0410 | Group psychotherapy other than of a multiple-family group, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes | ||
| G0411 | Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes | ||
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | ||
| H0002 | Behavioral health screening to determine eligibility for admission to treatment program | ||
| H0004 | Behavioral health counseling and therapy, per 15 minutes | ||
| H0017 | Behavioral health; residential (hospital residential treatment program), without room and board, per diem | ||
| H0018 | Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem | ||
| H0019 | Behavioral health; long-term residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem | ||
| H0031 | Mental health assessment, by non-physician | ||
| H0034 | Medication training and support, per 15 minutes | ||
| H0035 | Mental health partial hospitalization, treatment, less than 24 hours | ||
| H0036 | Community psychiatric supportive treatment, face-to-face, per 15 minutes | ||
| H0037 | Community psychiatric supportive treatment program, per diem | ||
| H0039 | Assertive community treatment, face-to-face, per 15 minutes | ||
| H0040 | Assertive community treatment program, per diem | ||
| H2000 | Comprehensive multidisciplinary evaluation | ||
| H2001 | Rehabilitation program, per 1/2 day | ||
| H2010 | Comprehensive medication services, per 15 minutes | ||
| H2011 | Crisis intervention service, per 15 minutes | ||
| H2012 | Behavioral health day treatment, per hour | ||
| H2013 | Psychiatric health facility service, per diem | ||
| H2014 | Skills training and development, per 15 minutes | ||
| H2015 | Comprehensive community support services, per 15 minutes | ||
| H2016 | Comprehensive community support services, per diem | ||
| H2017 | Psychosocial rehabilitation services, per 15 minutes | ||
| H2018 | Psychosocial rehabilitation services, per diem | ||
| H2019 | Therapeutic behavioral services, per 15 minutes | ||
| H2020 | Therapeutic behavioral services, per diem | ||
| M0064 | Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders | ||
| S0201 | Partial hospitalization services, less than 24 hours, per diem | ||
| S9480 | Intensive outpatient psychiatric services, per diem | ||
| S9484 | Crisis intervention mental health services, per hour | ||
| S9485 | Crisis intervention mental health services, per diem | ||
| T2048 | Behavioral health; long-term care residential (non-acute care in a residential treatment program where stay is typically longer than 30 days), with room and board, per diem | ||
| G9369 | Individual filled at least two prescriptions for any antipsychotic medication and had a pdc of 0.8 or greater | ||
| G9370 | Individual who did not fill at least two prescriptions for any antipsychotic medication or did not have a pdc of 0.8 or greater | ||
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 295.00 | Simple type schizophrenia, unspecified | ||
| 295.01 | Simple type schizophrenia, subchronic | ||
| 295.02 | Simple type schizophrenia, chronic | ||
| 295.03 | Simple type schizophrenia, subchronic with acute exacerbation | ||
| 295.04 | Simple type schizophrenia, chronic with acute exacerbation | ||
| 295.05 | Simple type schizophrenia, in remission | ||
| 295.10 | Disorganized type schizophrenia, unspecified | ||
| 295.11 | Disorganized type schizophrenia, subchronic | ||
| 295.12 | Disorganized type schizophrenia, chronic | ||
| 295.13 | Disorganized type schizophrenia, subchronic with acute exacerbation | ||
| 295.14 | Disorganized type schizophrenia, chronic with acute exacerbation | ||
| 295.15 | Disorganized type schizophrenia, in remission | ||
| 295.20 | Catatonic type schizophrenia, unspecified | ||
| 295.21 | Catatonic type schizophrenia, subchronic | ||
| 295.22 | Catatonic type schizophrenia, chronic | ||
| 295.23 | Catatonic type schizophrenia, subchronic with acute exacerbation | ||
| 295.24 | Catatonic type schizophrenia, chronic with acute exacerbation | ||
| 295.25 | Catatonic type schizophrenia, in remission | ||
| 295.30 | Paranoid type schizophrenia, unspecified | ||
| 295.31 | Paranoid type schizophrenia, subchronic | ||
| 295.32 | Paranoid type schizophrenia, chronic | ||
| 295.33 | Paranoid type schizophrenia, subchronic with acute exacerbation | ||
| 295.34 | Paranoid type schizophrenia, chronic with acute exacerbation | ||
| 295.35 | Paranoid type schizophrenia, in remission | ||
| 295.40 | Schizophreniform disorder, unspecified | ||
| 295.41 | Schizophreniform disorder, subchronic | ||
| 295.42 | Schizophreniform disorder, chronic | ||
| 295.43 | Schizophreniform disorder, subchronic with acute exacerbation | ||
| 295.44 | Schizophreniform disorder, chronic with acute exacerbation | ||
| 295.45 | Schizophreniform disorder, in remission | ||
| 295.50 | Latent schizophrenia, unspecified | ||
| 295.51 | Latent schizophrenia, subchronic | ||
| 295.52 | Latent schizophrenia, chronic | ||
| 259.53 | |||
| 295.54 | Latent schizophrenia, chronic with acute exacerbation | ||
| 295.55 | Latent schizophrenia, in remission | ||
| 295.60 | Schizophrenic disorders, residual type, unspecified | ||
| 295.61 | Schizophrenic disorders, residual type, subchronic | ||
| 295.62 | Schizophrenic disorders, residual type, chronic | ||
| 295.63 | Schizophrenic disorders, residual type, subchronic with acute exacerbation | ||
| 295.64 | Schizophrenic disorders, residual type, chronic with acute exacerbation | ||
| 295.65 | Schizophrenic disorders, residual type, in remission | ||
| 295.70 | Schizoaffective disorder, unspecified | ||
| 295.71 | Schizoaffective disorder, subchronic | ||
| 295.72 | Schizoaffective disorder, chronic | ||
| 295.73 | Schizoaffective disorder, subchronic with acute exacerbation | ||
| 295.74 | Schizoaffective disorder, chronic with acute exacerbation | ||
| 295.75 | Schizoaffective disorder, in remission | ||
| 295.80 | Other specified types of schizophrenia, unspecified | ||
| 295.81 | Other specified types of schizophrenia, subchronic | ||
| 295.82 | Other specified types of schizophrenia, chronic | ||
| 295.83 | Other specified types of schizophrenia, subchronic with acute exacerbation | ||
| 295.84 | Other specified types of schizophrenia, chronic with acute exacerbation | ||
| 295.85 | Other specified types of schizophrenia, in remission | ||
| 295.90 | Unspecified schizophrenia, unspecified | ||
| 295.91 | Unspecified schizophrenia, subchronic | ||
| 295.92 | Unspecified schizophrenia, chronic | ||
| 295.93 | Unspecified schizophrenia, subchronic with acute exacerbation | ||
| 295.94 | Unspecified schizophrenia, chronic with acute exacerbation | ||
| 295.95 | Unspecified schizophrenia, in remission | ||
| V11.0 | Personal history of schizophrenia | ||
| 290.0 | Senile dementia, uncomplicated | ||
| 290.10 | Presenile dementia, uncomplicated | ||
| 290.11 | Presenile dementia with delirium | ||
| 290.12 | Presenile dementia with delusional features | ||
| 290.13 | Presenile dementia with depressive features | ||
| 290.20 | Senile dementia with delusional features | ||
| 290.21 | Senile dementia with depressive features | ||
| 290.3 | Senile dementia with delirium | ||
| 290.40 | Vascular dementia, uncomplicated | ||
| 290.41 | Vascular dementia, with delirium | ||
| 290.42 | Vascular dementia, with delusions | ||
| 290.43 | Vascular dementia, with depressed mood | ||
| 291.2 | Alcohol-induced persisting dementia | ||
| 294.10 | Dementia in conditions classified elsewhere without behavioral disturbance | ||
| 294.11 | Dementia in conditions classified elsewhere with behavioral disturbance | ||
| 294.20 | Dementia, unspecified, without behavioral disturbance | ||
| 294.21 | Dementia, unspecified, with behavioral disturbance | ||
| 331.0 | Alzheimer's disease | ||
| 331.19 | Other frontotemporal dementia | ||
| 331.82 | Dementia with lewy bodies | ||
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| F20.0 | Paranoid schizophrenia | ||
| F20.1 | Disorganized schizophrenia | ||
| F20.2 | Catatonic schizophrenia | ||
| F20.3 | Undifferentiated schizophrenia | ||
| F20.5 | Residual schizophrenia | ||
| F20.81 | Schizophreniform disorder | ||
| F20.89 | Other schizophrenia | ||
| F20.9 | Schizophrenia, unspecified | ||
| F21 | Schizotypal disorder | ||
| F25.0 | Schizoaffective disorder, bipolar type | ||
| F25.1 | Schizoaffective disorder, depressive type | ||
| F25.8 | Other schizoaffective disorders | ||
| F25.9 | Schizoaffective disorder, unspecified | ||
| E75.00 | GM2 gangliosidosis, unspecified | ||
| E75.01 | Sandhoff disease | ||
| E75.02 | Tay-Sachs disease | ||
| E75.09 | Other GM2 gangliosidosis | ||
| E75.10 | Unspecified gangliosidosis | ||
| E75.11 | Mucolipidosis IV | ||
| E75.19 | Other gangliosidosis | ||
| E75.4 | Neuronal ceroid lipofuscinosis | ||
| F01.50 | Vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ||
| F01.51 | Vascular dementia with behavioral disturbance | ||
| F02.80 | Dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ||
| F02.81 | Dementia in other diseases classified elsewhere with behavioral disturbance | ||
| F03 | |||
| F03.90 | Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety | ||
| F03.91 | Unspecified dementia with behavioral disturbance | ||
| F05 | Delirium due to known physiological condition | ||
| F10.27 | Alcohol dependence with alcohol-induced persisting dementia | ||
| F10.97 | Alcohol use, unspecified with alcohol-induced persisting dementia | ||
| F13.27 | Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting dementia | ||
| F13.97 | Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting dementia | ||
| G30.0 | Alzheimer's disease with early onset | ||
| G30.1 | Alzheimer's disease with late onset | ||
| G30.8 | Other Alzheimer's disease | ||
| G30.9 | Alzheimer's disease, unspecified | ||
| G31.09 | Other frontotemporal neurocognitive disorder | ||
| G31.83 | Neurocognitive disorder with Lewy bodies | ||
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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