PQRS Measure
Report via: Registry, EHR
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 90791 | N/A | N/A | Psychiatric diagnostic evaluation |
| 90792 | N/A | N/A | Psychiatric diagnostic evaluation with medical services |
| 90832 | N/A | N/A | Psychotherapy, 30 minutes with patient |
| 90834 | N/A | N/A | Psychotherapy, 45 minutes with patient |
| 90837 | N/A | N/A | Psychotherapy, 60 minutes with patient |
| 90839 | N/A | N/A | Psychotherapy for crisis; first 60 minutes |
| 90845 | N/A | N/A | Psychoanalysis |
| 90849 | N/A | N/A | Multiple-family group psychotherapy |
| 90853 | N/A | N/A | Group psychotherapy (other than of a multiple-family group) |
| 99078 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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. |
| 99341 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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. |
| 90791 | N/A | N/A | Psychiatric diagnostic evaluation |
| 90792 | N/A | N/A | Psychiatric diagnostic evaluation with medical services |
| 90832 | N/A | N/A | Psychotherapy, 30 minutes with patient |
| 90834 | N/A | N/A | Psychotherapy, 45 minutes with patient |
| 90837 | N/A | N/A | Psychotherapy, 60 minutes with patient |
| 90839 | N/A | N/A | Psychotherapy for crisis; first 60 minutes |
| 90845 | N/A | N/A | Psychoanalysis |
| 90849 | N/A | N/A | Multiple-family group psychotherapy |
| 90853 | N/A | N/A | Group psychotherapy (other than of a multiple-family group) |
| 99078 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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. |
| 99341 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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. |
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| G0402 | N/A | N/A | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment |
| G8126 | N/A | N/A | Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase |
| G8127 | N/A | N/A | Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase |
| G8128 | N/A | N/A | Clinician documented that patient was not an eligible candidate for antidepressant medication during the entire 12 week acute treatment phase measure |
| G0402 | N/A | N/A | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment |
| G9194 | N/A | N/A | Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 180 day (6 month) continuation treatment phase |
| G9193 | N/A | N/A | Clinician documented that patient with a diagnosis of major depression was not an eligible candidate for antidepressant medication treatment or patient did not have a diagnosis of major depression |
| G9195 | N/A | N/A | Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 180 day (6 months) continuation treatment phase |
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 296.20 | N/A | N/A | Major depressive affective disorder, single episode, unspecified |
| 296.21 | N/A | N/A | Major depressive affective disorder, single episode, mild |
| 296.22 | N/A | N/A | Major depressive affective disorder, single episode, moderate |
| 296.23 | N/A | N/A | Major depressive affective disorder, single episode, severe, without mention of psychotic behavior |
| 296.24 | N/A | N/A | Major depressive affective disorder, single episode, severe, specified as with psychotic behavior |
| 296.25 | N/A | N/A | Major depressive affective disorder, single episode, in partial or unspecified remission |
| 296.30 | N/A | N/A | Major depressive affective disorder, recurrent episode, unspecified |
| 296.31 | N/A | N/A | Major depressive affective disorder, recurrent episode, mild |
| 296.32 | N/A | N/A | Major depressive affective disorder, recurrent episode, moderate |
| 296.33 | N/A | N/A | Major depressive affective disorder, recurrent episode, severe, without mention of psychotic behavior |
| 296.34 | N/A | N/A | Major depressive affective disorder, recurrent episode, severe, specified as with psychotic behavior |
| 296.35 | N/A | N/A | Major depressive affective disorder, recurrent episode, in partial or unspecified remission |
| 298.0 | N/A | N/A | Depressive type psychosis |
| 300.4 | N/A | N/A | Dysthymic disorder |
| 309.0 | N/A | N/A | Adjustment disorder with depressed mood |
| 309.1 | N/A | N/A | Prolonged depressive reaction |
| 311 | N/A | N/A | Depressive disorder, not elsewhere classified |
| 296.20 | N/A | N/A | Major depressive affective disorder, single episode, unspecified |
| 296.21 | N/A | N/A | Major depressive affective disorder, single episode, mild |
| 296.22 | N/A | N/A | Major depressive affective disorder, single episode, moderate |
| 296.23 | N/A | N/A | Major depressive affective disorder, single episode, severe, without mention of psychotic behavior |
| 296.24 | N/A | N/A | Major depressive affective disorder, single episode, severe, specified as with psychotic behavior |
| 296.25 | N/A | N/A | Major depressive affective disorder, single episode, in partial or unspecified remission |
| 296.30 | N/A | N/A | Major depressive affective disorder, recurrent episode, unspecified |
| 296.31 | N/A | N/A | Major depressive affective disorder, recurrent episode, mild |
| 296.32 | N/A | N/A | Major depressive affective disorder, recurrent episode, moderate |
| 296.33 | N/A | N/A | Major depressive affective disorder, recurrent episode, severe, without mention of psychotic behavior |
| 296.34 | N/A | N/A | Major depressive affective disorder, recurrent episode, severe, specified as with psychotic behavior |
| 296.35 | N/A | N/A | Major depressive affective disorder, recurrent episode, in partial or unspecified remission |
| 298.0 | N/A | N/A | Depressive type psychosis |
| 300.4 | N/A | N/A | Dysthymic disorder |
| 309.0 | N/A | N/A | Adjustment disorder with depressed mood |
| 309.1 | N/A | N/A | Prolonged depressive reaction |
| 311 | N/A | N/A | Depressive disorder, not elsewhere classified |
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| F32.0 | N/A | N/A | Major depressive disorder, single episode, mild |
| F32.1 | N/A | N/A | Major depressive disorder, single episode, moderate |
| F32.2 | N/A | N/A | Major depressive disorder, single episode, severe without psychotic features |
| F32.3 | N/A | N/A | Major depressive disorder, single episode, severe with psychotic features |
| F32.4 | N/A | N/A | Major depressive disorder, single episode, in partial remission |
| F32.9 | N/A | N/A | Major depressive disorder, single episode, unspecified |
| F33.0 | N/A | N/A | Major depressive disorder, recurrent, mild |
| F33.1 | N/A | N/A | Major depressive disorder, recurrent, moderate |
| F33.2 | N/A | N/A | Major depressive disorder, recurrent severe without psychotic features |
| F33.3 | N/A | N/A | Major depressive disorder, recurrent, severe with psychotic symptoms |
| F33.40 | N/A | N/A | Major depressive disorder, recurrent, in remission, unspecified |
| F33.41 | N/A | N/A | Major depressive disorder, recurrent, in partial remission |
| F33.8 | N/A | N/A | Other recurrent depressive disorders |
| F33.9 | N/A | N/A | Major depressive disorder, recurrent, unspecified |
| F34.1 | N/A | N/A | Dysthymic disorder |
| F32.0 | N/A | N/A | Major depressive disorder, single episode, mild |
| F32.1 | N/A | N/A | Major depressive disorder, single episode, moderate |
| F32.2 | N/A | N/A | Major depressive disorder, single episode, severe without psychotic features |
| F32.3 | N/A | N/A | Major depressive disorder, single episode, severe with psychotic features |
| F32.4 | N/A | N/A | Major depressive disorder, single episode, in partial remission |
| F32.9 | N/A | N/A | Major depressive disorder, single episode, unspecified |
| F33.0 | N/A | N/A | Major depressive disorder, recurrent, mild |
| F33.1 | N/A | N/A | Major depressive disorder, recurrent, moderate |
| F33.2 | N/A | N/A | Major depressive disorder, recurrent severe without psychotic features |
| F33.3 | N/A | N/A | Major depressive disorder, recurrent, severe with psychotic symptoms |
| F33.40 | N/A | N/A | Major depressive disorder, recurrent, in remission, unspecified |
| F33.41 | N/A | N/A | Major depressive disorder, recurrent, in partial remission |
| F33.8 | N/A | N/A | Other recurrent depressive disorders |
| F33.9 | N/A | N/A | Major depressive disorder, recurrent, unspecified |
| F34.1 | N/A | N/A | Dysthymic disorder |
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.
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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