Pqrs Cheat Sheet
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1PQRS Cheat Sheet
What is it?
PQRS is a Medicare program called the Physicians Quality Reporting System. Per the Patient Protection and Affordable Care Act
(aka Obamacare) participation in this program is mandatory beginning in 2015. If you do not accurately report on 50% or more of Medicare
claims from Jan. 1, 2015 to Dec. 31, 2015 then your reimbursement from Medicare will be reduced by 2% in 2017.
How do I participate?
There is no registration process for PQRS. You simply need to report on the measures applicable to DCs. These
measures are: Measure #131 Pain Assessment and Follow-up and Measure #182 Functional Outcome Assessment. To participate you must
report on BOTH measures.
To report
you would place a G-code on your claim form for your response to each of the Measures required. The G codes are 5 digit alpha-
numeric codes and would be placed in box 24D of your CMS 1500 form, the section of your claim form where CPT codes are entered. That’s all!
You must
report Measures #131 & #182 on every visit for every Medicare patient who is at least 18 years old.
This program applies to
all Traditional Medicare and Railroad Medicare. It does not apply to Medicare Advantage Plans or other
managed-care Medicare programs.
Measure # 131 – Pain Assessment and Follow-up
Provider Action
Code
Pain Assessment Documented as Positive AND Follow up Plan Documented
G8730
Pain Assessment Documented as negative, No follow-up plan documented
G8731
Patient not Eligible for Pain Assessment for Documented Reasons
G8442
Pain Assessment Documented, Follow-up plan not documented, Patient not Eligible/Appropriate
G8939
Pain Assessment not Documented, Reason not Specified
G8732
Pain Assessment Documented as Positive, Follow-up Plan not Documented, Reason not Specified
G8509
Measure # 182 – Functional Outcome Assessment
Provider Action
Code
Current Functional Outcome Assessment and Care Plan Documented
G8539
Current Functional Outcome Assessment Documented, no Functional Deficiencies Identified, Care Plan not Required
G8542
Functional Outcome Assessment and Treatment Plan Documented within the previous 30 days
G8942
Current Functional Outcome Assessment not Documented, Patient not Eligible
G8540
Current Functional Outcome Assessment Documented, Care Plan not Documented, Patient not Eligible
G9227
Current Functional Outcome not Documented, Reason not Specified
G8541
Current Functional Outcome Assessment Documented, Care Plan not Documented, Reason not Specified
G8543
Important Links
Provider Action
Code
ACA Guidebook to PQRS
CMS Guide to PQRS
CMS PQRS Help Desk
Phone: 866-288-8912 Email:
https://
Access to Feedback Report
NJ Medicare Administrator
If you do NOT successfully report on the PQRS measures in 50% of your claims from January 1, 2015 to
December 31, 2015, you will be PENALIZED 2% on all Medicare payments in 2017!!!
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