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

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   

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
90845N/AN/APsychoanalysis
92002N/AN/AOphthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient
92004N/AN/AOphthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits
92012N/AN/AOphthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient
92014N/AN/AOphthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits
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
96152N/AN/AHealth and behavior intervention, each 15 minutes, face-to-face; individual
97003N/AN/AOccupational therapy evaluation
97004N/AN/AOccupational therapy re-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.
99406N/AN/ASmoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
99407N/AN/ASmoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
4004F8PN/APatient screened for tobacco use and received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user (PV, CAD)
1036FN/AN/ACurrent tobacco non-user (CAD, CAP, COPD, PV) (DM) (IBD)
4004FN/AN/APatient screened for tobacco use and received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user (PV, CAD)
4004F1PN/APatient screened for tobacco use and received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user (PV, CAD)

HCPCS Codes

CodeModifierPOSDescription
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
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.

More information on these alternative reporting mechanisms is available at:
    http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.
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