2015 PQRS Quality Measures

February 09, 2015

Measures Codes

Measures codes contain information about Physician Quality Reporting System (PQRS) quality measures, including detailed specifications and related release notes for the individual PQRS quality measures and measures groups and other measures-related documentation needed by individual eligible professionals for reporting the PQRS measures through claims or qualified registry-based reporting.

The PQRS measure documents for the current program year may be different from the PQRS measure documents for a prior year. Eligible professionals are responsible for ensuring that they are using the PQRS measure documents for the correct program year. The 2015 PQRS CMS-1500 claim is an example of how an individual National Provider Identifier (NPI) reporting on a single CMS-1500 claim for 2015 PQRS should look. The following document that contains the 2015 PQRS CMS-1500 claim information is the 2015 Physician Quality Reporting System (PQRS) Implementation Guide.

Selecting Measures for 2015 PQRS

At a minimum, the following factors should be considered when selecting measures for reporting:

• Clinical conditions usually treated
• Types of care typically provided – e.g., preventive, chronic, acute
• Settings where care is usually delivered – e.g., office, emergency department (ED), surgical suite
• Quality improvement goals for 2015
• Other quality reporting programs in use or being considered

2015 Cross-Cutting Measures Requirement

In order for eligible professionals (EPs) to satisfactorily report Physician Quality Reporting System (PQRS) measures, a new reporting criterion has been added for the claims and registry reporting of individual measures. Eligible professionals or group practices are required to report one (1) cross-cutting measure if they have at least one (1) Medicare patient with a face-to-face encounter. The Centers for Medicare & Medicaid Services (CMS) defines a face-to-face encounter as an instance in which the EP billed for services that are associated with face-to-face encounters under the Physician Fee Schedule (PFS). This includes general office visits, outpatient visits, and surgical procedure codes; however, CMS does not consider telehealth visits as a face-to-face encounter.

Please reference the 2015 PQRS Measures List or the 2015 Cross-Cutting Measures List for broadly applicable measures that are defined as cross-cutting and reference the 2015 PQRS List of Face-To-Face Encounter Codes for the billable codes that identify face-to-face encounters for the purposes of 2015 PQRS reporting. Please note that an updated Face-to-Face Encounter Codes list is forthcoming. All stakeholders should be cognizant of the most up-to-date list and reference it for reporting purposes.

Resources for 2015 PQRS Measures

The following documents pertaining to the 2015 PQRS quality measures are included in the zip file titled 2015 PQRS Measures List:

• 2015 PQRS Implementation Guide – Provides guidance about how to select measures for reporting, how to read and understand a measure specification, and outlines the various reporting methods available for 2015 PQRS. The Implementation Guide also details how to implement claims-based reporting of measures to facilitate satisfactory reporting of quality-data codes by eligible professionals.
• 2015 PQRS Measures List – Identifies and describes the measures used in PQRS, including all available reporting methods/options, corresponding PQRS number and NQF number, NQS domains, plus measure developers and their contact information.

The following documents pertaining to the 2015 PQRS individual measures are included in the zip file titled 2015 PQRS Individual Claims Registry Measure Specification Supporting Documents.

• 2015 Physician Quality Reporting System (PQRS) Measure Specifications Manual for Claims and Registry Reporting of Individual Measures – Includes codes and reporting instructions for the 2015 PQRS measures for claims and/or registry-based reporting.
• 2015 Physician Quality Reporting System (PQRS) Measure Specification Release Notes – Outlines 2015 updates made to the 2014 PQRS Measures Specifications Manual in the form of release notes.
• 2015 Physician Quality Reporting System (PQRS) Quality-Data Code (QDC) Categories – Outlines, for each claims and registry measure, each QDC that should be reported for a corresponding quality action performed by the individual eligible professional as noted in the measures specification. This document identifies how each code will be used when CMS calculates performance rates. The QDC categories table also clarifies those measures that require 2 or more QDCs to report satisfactorily. Insufficiently reporting the QDCs (as specified in the 2015 PQRS measure specifications) will result as invalid reporting.
• 2015 Physician Quality Reporting System (PQRS) Single Source Code Master – Includes a numerical listing of all codes (denominator and numerator) included in 2015 PQRS Individual Claims and Registry Measures for incorporation into billing software.

The following documents pertaining to the 2015 PQRS measures groups are included in the zip file titled 2015 PQRS Measures Groups Specifications Supporting Documents:

• 2015 Physician Quality Reporting System (PQRS) Measures Groups Specifications Manual –Measures group specifications are different from those of the individual measures that form the group. Therefore, the specifications and instructions for measures group reporting are provided in a separate manual. The 2015 measures groups specifications include codes and reporting instructions for the PQRS measures groups for registry-based reporting.
• 2015 Physician Quality Reporting System (PQRS) Measures Groups Release Notes – Outlines 2015 updates made to the 2014 PQRS Measures Groups Specifications Manual in the form of release notes.
• 2015 Physician Quality Reporting System (PQRS) Getting Started with Measures Groups – Provides guidance about how to select measures groups for reporting, and how to read and understand a measure group specification in order to satisfactorily report.
• 2015 Physician Quality Reporting System (PQRS) Quality-Data Code (QDC) Categories – Outlines every QDC that should be reported for a corresponding quality action performed by the individual eligible professional as noted in the measures specification. This identifies how each code will be used when calculating performance rates. This also clarifies those measures that require two or more QDCs to report satisfactorily. Insufficiently reporting the QDCs (as specified in the 2015 PQRS) will result as invalid reporting. NOTE: Measures groups specifications may differ from their individual measures counterpart. This document will define the differences between the QDCs for individual and measure group specifications.
• 2015 Physician Quality Reporting System (PQRS) Measures Groups Single Source Code Master – Includes a numerical listing of all codes included in 2015 PQRS Measures Groups for incorporation into billing software.

2015 PQRS Individual Measures for Claims/Registry and Measures Groups Flow Documents

2015 PQRS Individual Measure Flow and Measure Group Flow documents are available as additional resources to assist in better understanding the reporting and performance algorithms for measures and measures groups. These measure flows should be utilized with the corresponding measure specification or measure group specification as they are supplemental documents. The Individual Measure Flows are included in the zip file titled 2015 PQRS Individual Measure Flows and Flow Manual. This zip file also includes an individual claims/registry measure flow manual to assist in interpreting the measure flows. The Measures Group Flows are included in the zip file titled 2015 PQRS Measures Groups Flows and Flow Manual. This zip file also includes a measures group flow manual to assist in interpreting the measures group flows.

Selecting Measures for 2014 PQRS

At a minimum, the following factors should be considered when selecting measures for reporting:

• Clinical conditions usually treated
• Types of care typically provided – e.g., preventive, chronic, acute
• Settings where care is usually delivered – e.g., office, emergency department (ED), surgical suite
• Quality improvement goals for 2014
• Other quality reporting programs in use or being considered

Resources for 2014 PQRS Measures

The following documents pertaining to the 2014 PQRS quality measures are included in the zip file titled 2014 Physician Quality Reporting System (PQRS) Implementation Guide:

• 2014 Physician Quality Reporting System (PQRS) Implementation Guide – Provides guidance about how to select measures for reporting, how to read and understand a measure specification, and outlines the various reporting methods available for 2014 PQRS. The Implementation Guide also details how to implement claims-based reporting of measures to facilitate satisfactory reporting of quality-data codes by eligible professionals.
• 2014 Physician Quality Reporting System (PQRS) Measures List – Identifies and describes the measures used in PQRS, including all available reporting methods/options, corresponding PQRS number and NQF number, NQS domains, plus measure developers and their contact information.

The following documents pertaining to the 2014 PQRS individual measures are included in the zip file titled 2014 PQRS Individual Claims Registry Measure Specification Supporting Documents:

• 2014 Physician Quality Reporting System (PQRS) Measure Specifications Manual for Claims and Registry Reporting of Individual Measures – Includes codes and reporting instructions for the 2014 PQRS measures for claims and/or registry-based reporting.
• 2014 Physician Quality Reporting System (PQRS) Measure Specification Release Notes – Outlines 2014 updates made to the 2013 PQRS Measures Specifications Manual in the form of release notes.
• 2014 Physician Quality Reporting System (PQRS) Quality-Data Code (QDC) Categories – Outlines, for each claims and registry measure, each QDC that should be reported for a corresponding quality action performed by the individual eligible professional as noted in the measures specification. This document identifies how each code will be used when CMS calculates performance rates. The QDC categories table also clarifies those measures that require 2 or more QDCs to report satisfactorily. Insufficiently reporting the QDCs (as specified in the 2014 PQRS measure specifications) will result as invalid reporting.
• 2014 Physician Quality Reporting System (PQRS) Single Source Code Master – Includes a numerical listing of all codes (denominator and numerator) included in 2014 PQRS Individual Claims and Registry Measures for incorporation into billing software.

The following documents pertaining to the 2014 PQRS measures groups are included in the zip file titled 2014 PQRS Measure Groups Specifications, Release Notes, Getting Started with 2014 PQRS Measures Groups, 2014 Quality-Data Code Categories, and 2014 PQRS Measures Groups Single Source Code Master:

• 2014 Physician Quality Reporting System (PQRS) Measures Groups Specifications Manual –Measures group specifications are different from those of the individual measures that form the group. Therefore, the specifications and instructions for measures group reporting are provided in a separate manual. The 2013 measures groups specifications include codes and reporting instructions for the 22 PQRS measures groups for claims or registry-based reporting.
• 2014 Physician Quality Reporting System (PQRS) Measures Groups Release Notes – Outlines 2013 updates made to the 2012 PQRS Measures Groups Specifications Manual in the form of release notes.
• 2014 Physician Quality Reporting System (PQRS) Getting Started with Measures Groups – Provides guidance about how to select measures groups for reporting, and how to read and understand a measure group specification in order to satisfactorily report.
• 2014 Physician Quality Reporting System (PQRS) Quality-Data Code (QDC) Categories – Outlines every QDC that should be reported for a corresponding quality action performed by the individual eligible professional as noted in the measures specification. This identifies how each code will be used when calculating performance rates. This also clarifies those measures that require two or more QDCs to report satisfactorily. Insufficiently reporting the QDCs (as specified in the 2013 PQRS) will result as invalid reporting. NOTE: Measures groups specifications may differ from their individual measures counterpart. This document will define the differences between the QDCs for individual and measure group specifications.
• 2014 Physician Quality Reporting System (PQRS) Measures Groups Single Source Code Master – Includes a numerical listing of all codes included in 2013 PQRS Measures Groups for incorporation into billing software.

Specialty Measure Sets

CMS is collaborating with specialty societies to ensure that the measures represented within Specialty Measure Sets accurately illustrate measures associated within a particular clinical area. The Specialty Measure Sets are to be utilized as a guide to assist eligible professionals to choose measures applicable to their specialty beginning in Program Year 2015. The Specialty Measure Sets are NOT required measures but are suggested measures for a specific specialty. The Specialty Measure Sets represent quality measures contained within 2014 Physician Quality Reporting System (PQRS) and new measures proposed for 2015 that may be applicable based on a particular clinical specialty.

The Specialty Measure Sets are indicated below.

It is important to utilize the measure specifications and program requirements within each reporting method chosen to satisfactorily report. Below are the links to the measure specifications for the different reporting options available in 2014 PQRS. Please note that measure specifications are not currently available for new measures proposed for 2015.

2015 PQRS Individual Claims Registry Measure Specification Supporting Documents:http://www.cms.gov/apps/ama/license.asp?file=/PQRS/downloads/2015_PQRS_IndividualMeasureSpecs_SupportingDocs_111214.zip

2015 PQRS Measure Groups Specifications Supporting Documents: 2015_PQRS_MeasuresGroupsSpecs_SupportingDocs_111214.zip

2014 PQRS EHR eCQMs: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/eCQM_Library.html

2014 PQRS Group Practice Reporting Option (GPRO) Web-Interface Narrative Measure Specifications:http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2014_GPROWebInterface_MeasuresList_NarrativeSpecs_ReleaseNotes_12132013.zip