Measures Codes

This page contains information about Physician Quality Reporting System quality measures, including detailed specifications and related release notes for the individual Physician Quality Reporting System quality measures and measures groups and other measures-related documentation needed by individual eligible professionals for reporting the Physician Quality Reporting System measures through claims or registry-based reporting.

Physician Quality Reporting System Call for Measures Deadline Ended on August 1, 2012

The deadline for submitting measures has now passed.

The Centers for Medicare & Medicaid Services (CMS) is no longer accepting measure suggestions for possible inclusion in the Physician Quality Reporting System for future rule-making years. The deadline for submitting measures closed on August 1, 2012.

Error Notice for Measure #235 Hypertension: Plan of Care

CMS has corrected the error that was identified related to the submission of Measure #235 “Hypertension: Plan of Care” for the 2012 Physician Quality Reporting System. The correction to the measure became effective as of April 2012 to allow providers the ability to submit with the correct G-codes. We apologize for any inconvenience this error has caused.

Not Otherwise Classified (NOC) PQRS G-codes 

It has come to our attention that certain Physician Quality Reporting System (PQRS) G-codes were inadvertently rejected by Carrier/MACS during the 2011 and 2012 program year. This only impacted Part B claims that were submitted utilizing the 5010 format. The problem has since been resolved and the codes have been reactivated. However, if your 2011 5010 claim was rejected, please be sure to resubmit your claim by February 24, 2012.

The following PQRS measures are affected by these codes:

#20     #100    #231   #273    #297
#32     #121    #236   #276    #298
#36     #123    #244   #278    #299
#40     #135    #263    #279   #300
#55     #202    #269    #295   #302
#79     #204    #271    #296   #317

It should be noted that the G-codes affected are predominantly the ones used to indicate that the provider did not perform the quality action and no reason was specified (performance failures).  

If you have questions, please contact the QualityNet Help Desk by clicking on the "Help Desk Support" link at left.

The Physician Quality Reporting System measure documents for the current program year may be different from the Physician Quality Reporting System measure documents for a prior year. Eligible professionals are responsible for ensuring that they are using the Physician Quality Reporting System measure documents for the correct program year.

2012 Physician Quality Reporting System

The following documents pertaining to the 2012 Physician Quality Reporting System are available in the "Downloads" section below in the zip file titled "2012 Physician Quality Reporting System Measure List and Implementation Guide": 

• 2012 Physician Quality Reporting System Implementation Guide.  This document provides guidance about how to select measures for reporting, how to read and understand a measure, and outlines the reporting options available for 2012 Physician Quality Reporting System. The Implementation Guide also details how to implement claims-based reporting of measures to facilitate satisfactory reporting of quality-data codes by eligible professionals.

• 2012 Physician Quality Reporting System Measures List.  This document identifies and explains the measures used in Physician Quality Reporting, including available reporting options/methods, measure developers and their contact information.

The following documents pertaining to the 2012 Physician Quality Reporting System individual measures are available in the "Downloads" section below titled "2012 Physician Quality Reporting System Measure Specification Manual, Release Notes, Single Source Code Master and Quality-Data Code Categories":

• 2012 Physician Quality Reporting System Measure Specifications Manual for Claims and Registry Reporting of Individual Measures.  The 2012 measure specifications include codes and reporting instructions for the 210 Physician Quality Reporting System measures for claims and/or registry-based reporting.

• 2012 Physician Quality Reporting System Measure Specification Release Notes. This document outlines changes from the 2011 Physician Quality Reporting System Measures Specifications Manual in the form of release notes.

• 2012 Physician Quality Reporting Quality-Data Code (QDC) Categories.  A table that outlines, for each measure, each QDC that should be reported for a corresponding quality action performed by the individual eligible professional as noted in the measures specification. This determines how each code will be used when calculating performance rates. This also clarifies those measures that require 2 or more QDCs to report satisfactorily. Insufficiently reporting the QDCs (as specified in the 2012 Physician Quality Reporting System measure specifications) will result in invalid reporting.

• 2012 Physician Quality Reporting Single Source Code Master. This file includes a numerical listing of all codes included in 2012 Physician Quality Reporting System Individual Claims and Registry Measures for incorporation into billing software.

The following documents pertaining to the 2012 Physician Quality Reporting System measures groups are available in the "Downloads" section below titled "2012 Physician Quality Reporting System Measure Groups Specifications and Release Notes, Getting Started with 2012 Measures Groups, 2012 Quality-Data Code Categories and 2012 Groups Single Source Code Master":

• 2012 Physician Quality Reporting Measures Groups Specifications Manual.  Measures group specifications are different from those of the individual measures that form the group. Therefore, the specifications and instructions for measures group reporting are provided in a separate manual. The 2012 measures groups specifications include codes and reporting instructions for the 22 Physician Quality Reporting System measures groups for claims or registry-based reporting.

• 2012 Physician Quality Reporting Measures Groups Release Notes.  This document outlines changes from the 2011 Physician Quality Reporting System Measures Groups Specifications Manual in the form of release notes.

• Getting Started with 2012 Physician Quality Reporting of Measures Groups. A guide to implementing the 2012 Physician Quality Reporting System measures groups.

• 2012 Physician Quality Reporting Quality-Data Code (QDC) Categories. A table that outlines, for each measure, each QDC that should be reported for a corresponding quality action performed by the individual eligible professional as noted in the measures specification. This determines how each code will be used when calculating performance rates. This also clarifies those measures that require 2 or more QDCs to report satisfactorily. Insufficiently reporting the QDCs (as specified in the 2012 Physician Quality Reporting System measure specifications) will result in invalid reporting.

• 2012 Physician Quality Reporting Measures Groups Single Source Code Master. This file includes a numerical listing of all codes included in 2012 Physician Quality Reporting System Measures Groups for incorporation into billing software.

Location of Previous Program Year Documents

All previous program year documents have been moved from this page and are now available on that specific program year section page at left.