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

Use this guide to select the appropriate G-codes for reporting data on PQRS.

The Physician Quality Reporting System (PQRS) is Medicare’s reporting program whereby health care professionals, including psychologists, submit data on specified quality measures to the Centers for Medicare and Medicaid Services (CMS). PQRS reporting consists of selecting measures that match your Medicare fee-for-service patients and identifying the 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.

The charts below provide an overview of the PQRS measures (in orange), applicable procedure codes and G-codes available for each measure. It includes measures available for claims-based and registry reporting. Prior to using this chart, psychologists will need to determine which measure is applicable by examining their Medicare population and identifying those beneficiaries for whom available PQRS measures would apply. 

Psychologists should note that for 2015 some measures previously available for claims-based reporting have been changed to Electronic Health Record (EHR) reporting or Registry reporting only. Those available for Registry reporting only appear in the chart below. 

The following measures are now limited to EHR reporting only:  

  • Measure #9: Major depressive disorder (MDD): Antidepressant medication during acute phase for patients with MDD.
  • Measure #107: Major depressive disorder: Suicide risk assessment.

Other PQRS measures formerly available have been eliminated altogether for 2015, including:  

  • Measure #106: Major depressive disorder: Diagnostic evaluation.
  • Measure #247: Substance use disorders: Counseling.
  • Measure #248: Substance use disorders: Screening for depression.

For additional materials and resources related to PQRS, visit the Quality Improvement Programs section at the APA Practice Organization’s Practice Central website.

Measure #128: Preventive care and screening: Body mass index screening and follow-up
Applicable Procedure Codes Action Taken G-Code (or F-code where applicable)

90791
90832
90834
90837
90839
96150
96151
96152

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 is documented
BMI calculated below normal parameters, follow-up documented G8418: Calculated BMI below normal parameters and a follow-up plan is 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 G8421: BMI not calculated no reason given
BMI calculated outside normal parameters, follow-up plan not documented, reason not given G8419: Calculated BMI outside normal parameters, no follow-up plan documented

Measure #130: Documentation and verification of current medications in the medical record
Applicable Procedure Codes Action Taken G-Code (or F-code where applicable)
90791
90832
90834
90837
90839
96116
96150
96151
96152
Current medications documented G8427: Eligible professional attests to documenting the patient’s
Current medications not documented, patient not eligible G8430: Eligible professional attests the patient is not eligible
Current medications with name, dosage, frequency, route not documented, reason not given G8428: Current medications not documented by the eligible professional, reason not given

Measure #131: Pain assessment prior to initiation of patient therapy and follow-up
Applicable Procedure Codes Action Taken G-Code (or F-code where applicable)
90791
96116
96118
96150
96151
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

Measure #134: Screening for clinical depression and follow-up plan
Applicable Procedure Codes Action Taken G-Code (or F-code where applicable)
90791
90832
90834
90837
90839
96116
96118
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
Screening for Clinical Depression Documented as Positive, Follow-Up Plan not Documented, Reason not Given G8511: Screening for clinical depression documented as positive, follow-up plan not documented, reason not given

Measure #173: Preventive care and screening: Unhealthy alcohol use — screening (Registry Reporting Only)
Applicable Procedure Codes Action Taken G-Code (or F-code where applicable)
90791
90832
90834
90837
90845
96150
96151
96152
Patient screened for unhealthy alcohol uses 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

Measure #181: Elder Maltreatment screen and follow-up plan
Applicable Procedure Codes Action Taken G-Code (or F-code where applicable)
90791
90832
90834
90837
96116
96150
96151
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: elder maltreatment screen, documented as positive follow-up plan not documented, reason not given

Measure #226: Preventive care and screening: tobacco use assessment and tobacco cessation
Applicable Procedure Codes Action Taken G-Code (or F-code where applicable)
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

Measure #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented (Follow-up includes referral to alternative/primary care provider)
Applicable Procedure Codes Action Taken G-Code (or F-code where applicable)
90791
90832
90834
90837
90839
90845
90880
96118
Performance met G8783: Normal blood pressure reading documented; follow-up not required
Performance met G8950: Pre-hypertensive or hypertensive blood pressure reading documented, AND the indicated follow-up is documented
Performance exclusion G8784: Blood pressure reading not documented, documentation the patient is not eligible
Performance exclusion G8951: Pre-hypertensive or hypertensive blood pressure reading documented, Indicated follow-up not documented, documentation the patient is not eligible
Performance not met G8785: Blood pressure reading not documented, reason not given
Performance not met G8952: Pre-hypertensive or hypertensive blood pressure reading documented,indicated follow-up not documented, reason not given

Measure #325: Adult Major Depressive Disorder (MDD): Coordination of Care of Patients with Specific Comorbid Conditions (Registry Reporting Only)
Applicable Procedure Codes Action Taken G-Code (or F-code where applicable)
90791 
90832 
90834 
90837 
90845
Performance met G8959: Clinician treating MDD communicates to clinician treating comorbid condition
Patient performance exclusion G9232: Clinician treating MDD did not communicate to clinician treating comorbid conditions for specified patient reason
Performance not met G8960: Clinician treating MDD did not communicate to clinician treating comorbid condition, reason not given

Measure #383: Adherence to Antipsychotic Medications for Individuals with Schizophrenia (Registry Reporting Or EHR Reporting Only)
Applicable Procedure Codes Action Taken G-Code (or F-code where applicable)
90785, 90791
90832, 90834
90837, 90845
90847, 90849
90853
Performance met G9369: Individual filled at least two prescriptions for any antipsychotic medication and had a PDC of 0.8 or greater
Performance not met G9370: Individual did not fill at least two prescriptions of any antipsychotic medication and did not have a PDC of 0.8 or greater

Dementia Measures Group (Registry Reporting Only)
Applicable Procedure Codes
90791
90832
90834
90837
96116
96120
96150
96151
96152
96154
Measures groups are a subset of four or more PQRS measures that have a particular clinical condition or focus in common. All applicable measures within a group must be reported for each patient within the sample that meets the required criteria (such as age or gender). G Codes are reported by the Registry
#47: Care Plan
#280: Dementia: Staging of Dementia
#281: Dementia: Cognitive Assessment
#282: Dementia: Functional Status Assessment
#283: Dementia: Neuropsychiatric Symptom Assessment
#284: Dementia: Management of Neuropsychiatric Symptoms
#285: Dementia: Screening for Depressive Symptoms
#286: Dementia: Counseling Regarding Safety Concerns
#287: Dementia: Counseling Regarding Risks of Driving
#288: Dementia: Caregiver Education and Support