PQRS Measure
Report via: Claim, Registry, EHR, Measure Group
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 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. | ||
| 3315F | Estrogen receptor (ER) or progesterone receptor (PR) positive breast cancer (ONC) | ||
| 3315F | Estrogen receptor (ER) or progesterone receptor (PR) positive breast cancer (ONC) | ||
| 3315F | Estrogen receptor (ER) or progesterone receptor (PR) positive breast cancer (ONC) | ||
| 3315F | Estrogen receptor (ER) or progesterone receptor (PR) positive breast cancer (ONC) | ||
| 3316F | Estrogen receptor (ER) and progesterone receptor (PR) negative breast cancer (ONC) | ||
| 3316F | 8P | Estrogen receptor (ER) and progesterone receptor (PR) negative breast cancer (ONC) | |
| 3370F | AJCC Breast Cancer Stage 0 documented (ONC) | ||
| 3370F | 8P | AJCC Breast Cancer Stage 0 documented (ONC) | |
| 3372F | AJCC Breast Cancer Stage I: T1mic, T1a or T1b (tumor size <= 1 cm) documented (ONC) | ||
| 3374F | AJCC Breast Cancer Stage I: T1c (tumor size > 1 cm to 2 cm) documented (ONC) | ||
| 3374F | AJCC Breast Cancer Stage I: T1c (tumor size > 1 cm to 2 cm) documented (ONC) | ||
| 3374F | AJCC Breast Cancer Stage I: T1c (tumor size > 1 cm to 2 cm) documented (ONC) | ||
| 3374F | AJCC Breast Cancer Stage I: T1c (tumor size > 1 cm to 2 cm) documented (ONC) | ||
| 3376F | AJCC Breast Cancer Stage II documented (ONC) | ||
| 3376F | AJCC Breast Cancer Stage II documented (ONC) | ||
| 3376F | AJCC Breast Cancer Stage II documented (ONC) | ||
| 3376F | AJCC Breast Cancer Stage II documented (ONC) | ||
| 3378F | AJCC Breast Cancer Stage III documented (ONC) | ||
| 3378F | AJCC Breast Cancer Stage III documented (ONC) | ||
| 3378F | AJCC Breast Cancer Stage III documented (ONC) | ||
| 3378F | AJCC Breast Cancer Stage III documented (ONC) | ||
| 3380F | AJCC Breast Cancer Stage IV documented (ONC) | ||
| 4179F | 1P | Tamoxifen or aromatase inhibitor (AI) prescribed (ONC) | |
| 4179F | 2P | Tamoxifen or aromatase inhibitor (AI) prescribed (ONC) | |
| 4179F | 3P | Tamoxifen or aromatase inhibitor (AI) prescribed (ONC) | |
| 4179F | Tamoxifen or aromatase inhibitor (AI) prescribed (ONC) | ||
| 4179F | Tamoxifen or aromatase inhibitor (AI) prescribed (ONC) | ||
| 4179F | 8P | Tamoxifen or aromatase inhibitor (AI) prescribed (ONC) | |
| 4179F | 8P | Tamoxifen or aromatase inhibitor (AI) prescribed (ONC) | |
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 174.0 | Malignant neoplasm of nipple and areola of female breast | ||
| 174.1 | Malignant neoplasm of central portion of female breast | ||
| 174.2 | Malignant neoplasm of upper-inner quadrant of female breast | ||
| 174.3 | Malignant neoplasm of lower-inner quadrant of female breast | ||
| 174.4 | Malignant neoplasm of upper-outer quadrant of female breast | ||
| 174.5 | Malignant neoplasm of lower-outer quadrant of female breast | ||
| 174.6 | Malignant neoplasm of axillary tail of female breast | ||
| 174.8 | Malignant neoplasm of other specified sites of female breast | ||
| 174.9 | Malignant neoplasm of breast (female), unspecified | ||
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| C50.011 | Malignant neoplasm of nipple and areola, right female breast | ||
| C50.012 | Malignant neoplasm of nipple and areola, left female breast | ||
| C50.019 | Malignant neoplasm of nipple and areola, unspecified female breast | ||
| C50.111 | Malignant neoplasm of central portion of right female breast | ||
| C50.112 | Malignant neoplasm of central portion of left female breast | ||
| C50.119 | Malignant neoplasm of central portion of unspecified female breast | ||
| C50.211 | Malignant neoplasm of upper-inner quadrant of right female breast | ||
| C50.212 | Malignant neoplasm of upper-inner quadrant of left female breast | ||
| C50.219 | Malignant neoplasm of upper-inner quadrant of unspecified female breast | ||
| C50.311 | Malignant neoplasm of lower-inner quadrant of right female breast | ||
| C50.312 | Malignant neoplasm of lower-inner quadrant of left female breast | ||
| C50.319 | Malignant neoplasm of lower-inner quadrant of unspecified female breast | ||
| C50.411 | Malignant neoplasm of upper-outer quadrant of right female breast | ||
| C50.412 | Malignant neoplasm of upper-outer quadrant of left female breast | ||
| C50.419 | Malignant neoplasm of upper-outer quadrant of unspecified female breast | ||
| C50.511 | Malignant neoplasm of lower-outer quadrant of right female breast | ||
| C50.512 | Malignant neoplasm of lower-outer quadrant of left female breast | ||
| C50.519 | Malignant neoplasm of lower-outer quadrant of unspecified female breast | ||
| C50.611 | Malignant neoplasm of axillary tail of right female breast | ||
| C50.612 | Malignant neoplasm of axillary tail of left female breast | ||
| C50.619 | Malignant neoplasm of axillary tail of unspecified female breast | ||
| C50.811 | Malignant neoplasm of overlapping sites of right female breast | ||
| C50.812 | Malignant neoplasm of overlapping sites of left female breast | ||
| C50.819 | Malignant neoplasm of overlapping sites of unspecified female breast | ||
| C50.911 | Malignant neoplasm of unspecified site of right female breast | ||
| C50.912 | Malignant neoplasm of unspecified site of left female breast | ||
| C50.919 | Malignant neoplasm of unspecified site of unspecified female breast | ||
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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