Year:  2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 

PQRS Measure

 Report via: Claim, Registry, EHR, GPRO/ACO

The following codes apply for this PQRS measure:

CPT Codes

CodeModifierPOSDescription
90791N/AN/APsychiatric diagnostic evaluation
90792N/AN/APsychiatric diagnostic evaluation with medical services
90832N/AN/APsychotherapy, 30 minutes with patient
90834N/AN/APsychotherapy, 45 minutes with patient
90837N/AN/APsychotherapy, 60 minutes with patient
90839N/AN/APsychotherapy for crisis; first 60 minutes
92557N/AN/AComprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined)
92567N/AN/ATympanometry (impedance testing)
92568N/AN/AAcoustic reflex testing, threshold
92625N/AN/AAssessment of tinnitus (includes pitch, loudness matching, and masking)
92626N/AN/AEvaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); first hour
96116N/AN/ANeurobehavioral 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
96118N/AN/ANeuropsychological 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
96150N/AN/AHealth 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
96151N/AN/AHealth 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
97003N/AN/AOccupational therapy evaluation
99201N/AN/AOffice 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.
99202N/AN/AOffice 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.
99203N/AN/AOffice 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.
99204N/AN/AOffice 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.
99205N/AN/AOffice 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.
99212N/AN/AOffice 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.
99213N/AN/AOffice 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.
99214N/AN/AOffice 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.
99215N/AN/AOffice 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

CodeModifierPOSDescription
G0101N/AN/ACervical or vaginal cancer screening; pelvic and clinical breast examination
G0402N/AN/AInitial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
G0438N/AN/AAnnual wellness visit; includes a personalized prevention plan of service (pps), initial visit
G0439N/AN/AAnnual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
G0444N/AN/AAnnual depression screening, 5 to 15 minutes
G8431N/AN/AScreening for depression is documented as being positive and a follow-up plan is documented
G8431N/AN/AScreening for depression is documented as being positive and a follow-up plan is documented
G8432N/AN/ADepression screening not documented, reason not given
G8432N/AN/ADepression screening not documented, reason not given
G8433N/AN/AScreening for depression not completed, documented patient or medical reason
G8510N/AN/AScreening for depression is documented as negative, a follow-up plan is not required
G8510N/AN/AScreening for depression is documented as negative, a follow-up plan is not required
G8511N/AN/AScreening for depression documented as positive, follow-up plan not documented, reason not given
G8511N/AN/AScreening for depression documented as positive, follow-up plan not documented, reason not given
G8940N/AN/AScreening for depression documented as positive, a follow-up plan not completed, documented reason
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.
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