Quick reference guide for PQRS measures, procedure codes and G-codes

Once an eligible patient and measure are identified, use this chart to select the appropriate procedure and G-code

By Government Relations staff

Formerly known as the Physician Quality Reporting Initiative (PQRI), the Physician Quality Reporting System is a voluntary reporting program that provides a financial incentive for certain health care professionals, including psychologists, who participate in Medicare to submit data on specified quality measures to the Centers for Medicare and Medicaid Services (CMS). In 2015, the reporting program will shift from an incentive program that offers bonuses for successful reporting to one in which penalties will be assessed for failure to participate.

Reporting in PQRS consists of selecting measures that match your Medicare population and identifying the types of services you provide to those patients. Medicare asks that you indicate whether or not the action described by the measures was taken through the use of a code (known as a “G” code) specific to each measure.

This chart provides a quick summary of Physician Quality Reporting System (PQRS) measures (in orange) and the procedure codes and G-codes available for each measure, based upon action taken. Prior to using this chart, providers will need to determine which measure is applicable by examining their Medicare patient population and identifying those who have a diagnosis covered by an eligible measure.

For more information on identifying eligible patients and measures, view the video on How to Report in the Physician Quality Reporting System. For additional materials and resources related to PQRS, visit the Quality Improvement Programs section at the APA Practice Organization’s Practice Central website.

Applicable procedure codes

Action taken

G-code (or F-code where applicable)

#106: Major depressive disorder: diagnostic evaluation

90791, 90832,
90834, 90837, 
90845
DSM-IV-TR criteria for Major Depressive Disorder documented (One CPT II code & one G-code [1040F & G8930] are required on the claim form to submit this numerator option)

CPT II 1040F: DSM-IV-TR criteria for major depressive disorder documented at the initial evaluation 

and

G8930: Assessment of depression severity at the initial evaluation

DSM-IV-TR criteria for Major Depressive Disorder not documented, reason not otherwise specified (One CPT II code [1040-8P] or one G-code [G8931] are required on the claim form to submit this numerator option)

1040F with 8P: DSM-IV-TR criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified

or  

G8931: Assessment of depression severity not documented, reason not given

#107: Major depressive disorder: suicide risk assessment

90791, 90832,
90834, 90837, 
90845
Suicide risk assessed G8932: Suicide risk assessed at the initial evaluation
Patient is not eligible for this measure because MDD is in remission CPT II 3092F: Major depressive disorder, in remission
Suicide risk not assessed, reason not given G8933: Suicide risk not assessed at the initial evaluation, reason not given

#128: Preventive care and screening: Body mass index screening and follow-up

90791, 90832,
90834, 90837
BMI calculated as normal, no follow-up plan required G8420: Calculated BMI within normal parameters and documented
BMI calculated above normal parameters, follow-up documented G8417: Calculated BMI above normal parameters and a follow-up plan was documented
BMI calculated below normal parameters, follow-up documented G8418: Calculated BMI below normal parameters and a follow-up plan was documented
BMI not calculated, patient not eligible/not appropriate G8422: Patient not eligible for BMI calculation
BMI calculated, patient not eligible/not appropriate for follow-up plan G8938: BMI is calculated, but patient not eligible for follow-up plan
BMI not calculated, reason not given G842 1: BMI not calculated
BMI calculated outside normal parameters, follow-up plan not documented, reason not given G8419: Calculated BMI outside normal parameters, no follow-up plan documented

#130: Documentation and verification of current medications in the medical record

90791, 90832,
90834, 90837,
90839, 96116,
96150, 96152
Current medications documented G8427: Eligible professional attests to documenting the patient’s current medications to the best of his/her knowledge and ability
Current medications not documented, patient not eligible G8430: Eligible professional attests the patient is not eligible for medication documentation
Current medications with name, dosage, frequency, route not documented, reason not given G8428: Current medications not documented by the eligible professional, reason not given

#131: Pain assessment prior to initiation of patient therapy and follow-up

90791, 96116, 96150 Pain assessment documented as positive G8730: Pain assessment documented as positive utilizing a standardized tool and a follow-up plan is documented
Pain assessment documented as negative, no follow-up plan required G8731: Pain assessment documented as negative, no follow-up plan required
Patient not eligible for pain assessment for documented reasons G8442: Documentation that patient is not eligible for a pain assessment
Pain assessment documented, follow-up plan not documented, patient not eligible/appropriate G8939: Pain assessment documented, follow-up plan not documented, patient not eligible/appropriate
Pain assessment not documented, reason not given G8732: No documentation of pain assessment, reason not given
Pain assessment documented as positive, follow-up plan not documented, reason not given G8509: Documentation of positive pain assessment; no documentation of a follow-up plan, reason not given

#134: Screening for clinical depression and follow-up plan

90791, 90832,
90834, 90837, 96150, 96151
Positive screen for clinical depression documented, follow-up plan documented G8431: Positive screen for clinical depression with a documented follow-up plan
Negative screen for clinical depression documented, follow-up plan not required G8510: Negative screen for clinical depression, follow-up not required
Screening for clinical depression not documented, patient not eligible/appropriate G8433: Screening for clinical depression not documented, patient not eligible/appropriate
Screening for clinical depression documented, follow-up plan not documented, patient not eligible/appropriate G8940: Screening for clinical depression documented, follow-up plan not documented, patient not eligible/appropriate
Screening for clinical depression not documented, reason not given G8432: Clinical depression screening not documented, reason not given

#181: Elder maltreatment screen and follow-up plan

90791, 96116,
96150
Elder maltreatment screen documented as positive and follow-up plan documented G8733: Documentation of a positive elder maltreatment screen and documented follow-up plan at the time of the positive screen
Elder maltreatment screen documented as negative, follow-up plan not required G8734: Elder maltreatment screen documented as negative, no follow-up required
Elder maltreatment screen not documented, patient not eligible G8535: No documentation of an elder maltreatment screen, patient not eligible
Elder maltreatment screen documented, patient not eligible for follow-up G8941: Elder Maltreatment Screen Documented, Patient not Eligible for Follow-Up
Elder maltreatment screen not documented, reason not given G8536: No documentation of an elder maltreatment screen, reason not given
Elder maltreatment screen documented as positive, follow-up plan not documented, reason not given G8735: No documentation of an elder maltreatment screen, patient not eligible

#226: Preventive care and screening: Tobacco use assessment and tobacco cessation intervention

90791, 90832,
90834, 90837, 
90845, 96150, 96151, 96152
Patient screened for tobacco use CPT II 4004F: Patient screened for tobacco use and received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user
Patient screened for tobacco use and identified as a non-user of tobacco CPT II 1036F: Current tobacco non-user
Tobacco screening not performed for medical reasons 4004F with 1P: Documentation of medical reason(s) for not screening for tobacco use (eg, limited life expectancy, other medical reason)
Tobacco screening or tobacco cessation intervention not performed reason not otherwise specified 4004F with 8P: Tobacco screening or tobacco cessation intervention not performed, reason not otherwise specified

#247: Substance use disorders – counseling

90791, 90832,
90834, 90837, 
90845, 96150, 96152
Patient counseled regarding psychosocial and pharmacologic treatment options for alcohol dependence CPT II 4320F: Patient counseled regarding psychosocial and pharmacologic treatment options for alcohol dependence
Patient not counseled regarding psychosocial and pharmacologic treatment options for alcohol dependence, reason not otherwise specified 4320F with 8P: Patient was not counseled regarding psychosocial and pharmacologic treatment options for alcohol dependence, reason not otherwise specified

#248: Substance use disorders Screening for depression

90791, 90832,
90834, 90837, 
90845, 96150, 96152
Patient screened for depression CPT II 1220F: Patient screened for depression
Patient not screened for depression for medical reasons 1220F with 1P: Documentation of medical reason(s) for not screening for depression
Patient not screened for depression, reason not otherwise specified 1220F with 8P: Patient was not screened for depression, reason not otherwise specified

#325: Adult Major Depressive Disorder (MDD): Coordination of Care of Patients with Specific Comorbid Conditions – Note: Registry Reporting Only

90791, 90832, 90834, 90837, 
90845
Clinician treating Major Depressive Disorder communicates to clinician treating comorbid condition G8959:Clinician treating MDD communicates to clinician treating comorbid condition
Clinician treating Major Depressive Disorder did not communicate to clinician treating comorbid condition, reason not given G8960: Clinician treating MDD did not communicate to clinician treating comorbid condition, reason not given

Measures Available Only Through Registry Reporting

Measure #9: Major depressive disorder: antidepressant medication during acute phase for patients with MDD

90791, 90832,
90834, 90837, 
90845, 90849, 90853
Acute treatment with antidepressant medication G8126: Patient with new episode of MDD documented as being treated with antidepressant medication during the entire 12 week acute treatment phase
Acute treatment with antidepressant medication not completed for documented reasons G8128: Clinician documented that patient with a new episode of MDD was not an eligible candidate for antidepressant medication treatment or patient did not have a new episode of MDD
Acute treatment with antidepressant medication not completed, reason not given G8127: Patient with new episode of MDD not documented as being treated with antidepressant medication during the entire 12 week acute treatment phase

#173: Preventive care and screening: Unhealthy alcohol use—screening

90791, 90832,
90834, 90837, 
90845, 96150, 96152
Patient screened for unhealthy alcohol use using a systematic screening method CPT II 3016F
Unhealthy alcohol use screening not performed, for medical reasons 3016F with 1P: Documentation of medical reason(s) for not screening for unhealthy alcohol use (eg, limited life expectancy, other medical reasons)
Unhealthy alcohol use screening not performed, reason not otherwise specified 3016F with 8P: Unhealthy alcohol use screening not performed, reason not otherwise specified

 

Updated January 2014

Current procedural terminology (CPT®) copyright 2011 American Medical Association. All Rights Reserved.