More frequently asked questions about PQRS

APA Practice Organization staff addresses issues related to participating in Medicare’s quality reporting program.

By Government Relations staff

March 14, 2013—The Medicare Physician Quality Reporting System (PQRS), formerly an incentive-based program, is set to switch to one in which penalties will be assessed for failure to report. Practitioners who don't yet participate in PQRS must begin, must begin doing so in 2013 or they will face payment penalties starting in 2015.

The APA Practice Organization (APAPO) has been providing information to members through the PracticeUpdate e-newsletter and on the Practice Central website about participating in the program. This article reflects some of the most frequent questions practitioners still have about PQRS.

Additional questions and answers are available in the Quality Improvement Programs section of APAPO’s Practice Central website.

The PQRS instructions talk about entering G codes on the 1500 claims form. What are G codes and where do I find them?

G codes are used to indicate whether or not you performed the activity associated with the measure. For example, if reporting on measure #9, Major Depressive Disorder (MDD): Antidepressant Medication During Acute Phase, you would select one of the following G codes:

  • G8126: Patient with new episode of MDD documented as being treated with antidepressant medication during the entire 12 week acute treatment phase.

  • G8127: Patient with new episode of MDD not documented as being treated with antidepressant medication during the entire 12 week acute treatment phase.

  • 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.

The G code numbers and descriptions are specific to each measure and can be found in the Numerator section of each measure in the 2013 PQRS Measures Specification Manual. APAPO also created a Quick Reference Guide for Measures, Procedures and G-codes to assist practitioners in selecting the appropriate reporting codes.

What if I can’t find any measures that apply to my practice?

Because mental health professionals have a limited number of PQRS measures to choose from, some psychologists may not have Medicare patients whose diagnosis and treatment matches any of the measures. Psychologists in this situation are advised to contact CMS’ QualityNet Help Desk for assistance in reviewing the measures. If QualityNet cannot identify applicable measures for your patient population they will ensure you are not penalized for not reporting.

QualityNet Help Desk can be reached by telephone at (866) 288-8912 or via email.

As a psychologist employed by a facility that provides mental health services, am I still eligible to participate in PQRS?

Yes, as long as your professional services are paid under or based on the Medicare Physician Fee Schedule (PFS), those services are eligible for PQRS incentives and/or payment adjustments.

Even though the facility may be billing Medicare Part B on your behalf, you are still considered an eligible professional who can report through PQRS. You should speak with the facility’s billing office to coordinate how your PQRS data is submitted to CMS.

My practice involves neuropsychological testing, not psychotherapy. Are there any PQRS measures that I can report?

Psychologists who provide neuropsychological testing services, as well as psychotherapy or health and behavior services, to patients with dementia may be able to report on the Dementia Measures Group. Reporting on a Measures Group can be done on the 1500 claims form or through a registry but the requirements are different than they are for individual claims. You must have 20 unique Medicare Part B fee for service patients in your sample and you must report on all nine measures in the Dementia Group.

The measures in the Dementia Measures Group are:

  • #280 – Staging of Dementia

  • #281 – Cognitive Assessment

  • #282 – Functional Status Assessment

  • #283 – Neuropsychiatric Symptom Assessment

  • #284 – Management of Neuropsychiatric Symptoms

  • #285 – Screening for Depressive Symptoms

  • #286 – Counseling Regarding Safety Concerns

  • #287 – Counseling Regarding Risks of Driving

  • #288 – Caregiver Education and Support

Detailed information about how to report the Dementia Measures Group is located in a separate document titled The 2013 CMS Measures Group Specification Manual.