American Speech-Language-Hearing Association

PQRS Measures Available for SLPs to Report on Claims

Medication Management and Pain Management

The Centers for Medicare and Medicaid Services (CMS) finalized rules that require providers to report at least nine measures and 1 "cross-cutting measure" for a minimum of 50% of the eligible Medicare patient visits in order to avoid future penalties. Because SLPs do not have nine measures that apply, their claims will be subject to a Measure Applicability Validation (MAV) process that confirms they have positively reported on a minimum of 50% of the eligible Medicare patient visits for:

SLPs are not required to report all three measures, but must meet the minimum reporting threshold for at least one measure.

Each measure is reportable via the CMS-1500 claim form using Current Procedural Terminology (CPT) codes and specified PQRS G-codes, outlined in each measure below.

For questions regarding these measures, contact ASHA or the CMS PQRS Helpdesk.

In order to avoid a 2% penalty in 2017, a minimum of 50% of eligible Medicare claims must included a positive action PQRS G-code from at least one of the measures below. Positive action codes are indicated with **.

Measure #130: Documentation of Current Medications in the Medical Record

Measure #130 attests that the clinician made the best efforts to document a current, complete, and accurate list of medications in the medical record for the patient encounter. It is a measure that is applicable to all disciplines and represents a best practice standard. Documentation of medications in the medical record may include acknowledgment in the electronic health record that the medications have been reviewed and there are no changes, as indicated by the patient, or it may include a list documented in the progress note. This measure does not include a pharmacological assessment.

To avoid the 2% payment reduction in 2017, the documentation of medication must be reported a minimum of 50% of the eligible Medicare Part B patient visits in the 2015 calendar year. An eligible patient visit is every time a patient is seen and a claim is submitted for the of the CPT codes below.

Measure Details

Reporting Criteria
Patients 18 years or older with the following procedure codes
CPT Codes
92507, 92508, 92526, 92626, 97532
G-Codes
G8427** Provider documentation of medications the patient is presently taking, including:
  • Prescriptions
  • Over-the-Counter Drugs
  • Herbals
  • Vitamin/Mineral/Dietary/Nutritional Supplements
Documentation should include:
  • Name of Medication
  • Dosage (how much)
  • Frequency (how often)
  • Route (oral, injection)
G8427 should also be reported if the clinician documented that the patient is currently not taking any medications. The medication information can be received from the patient, authorized representative(s), caregiver(s), or other available health care resources (e.g., electronic health record).The documentation or review of the medications must be performed by the provider reporting this code and noted appropriately in the medical record.
G8430** Provider documentation that patient is not eligible for medication assessment because the patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient’s health status
G8428 Current medications not documented by the provider, reason not specified.
How do I report on this measure? Find out using this easy-to-follow flow chart and sample claim form [PDF].

Measure #131: Pain Assessment and Follow-Up

Reporting Measure #131 indicates that the clinician has performed an assessment of the presence or absence of pain using a standardized tool. The assessment may include the characteristics of the pain: location, intensity, quality, onset, and duration. A follow-up plan must be documented, and can be a referral to a physician or other specialist, or a return visit for re-assessment or treatment.

A standardized pain assessment tool must be selected for the population in which it is used. Examples included in the CMS Measures Specification Manual include the Brief Pain Inventory (BPI), Faces Pain Scale (FPS), McGill Pain Questionnaire (MPQ), Multidimensional Pain Inventory (MPI), Neuropathic Pain Scale (NPS), Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ), Verbal Descriptor Scale (VDS), Verbal Numeric Rating Scale (VNRS), and Visual Analog Scale (VAS).

To avoid the 2% payment reduction in 2017, the pain assessment and appropriate follow-up must be documented and reported on a minimum of 50% of the eligible Medicare Part B patient visits for the 2015 calendar year.

Measure Details

Reporting Criteria
Patients 18 years or older with the following procedure codes
CPT Codes
92507, 92508, 92526, 97532
G-Codes
G8730** Pain assessment measured by standardized tool is positive and follow-up plan is documented.
G8731** Pain assessment measured by standardized tool is negative; no follow-up plan required.
G8442** Patient is not eligible for pain assessment because one or both of the following reasons exist:
  • Severe mental and/or physical incapacity where the person is unable to express himself/herself in a manner understood by others
  • Patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient’s health status
G8939** Pain assessment measured by standardized tool is documented, but patient is not eligible for follow-up plan
  • Severe mental and/or physical incapacity where the person is unable to express himself/herself in a manner understood by others
  • Patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient’s health status
G8732 No documentation of pain assessment, reason not specified
G8509 Pain assessment measured by standardized tool is positive, but no documentation of a follow-up plan, reason not specified
For an example of how measures are reported, see the medication management flow chart and sample claim form [PDF].

Measure #317: Screening for High Blood Pressure and Follow-Up

Reporting Measure #317 is an option for SLPs who bill 97532 Development of cognitive skills and are trained to measure a patient’s blood pressure, classify the result as normal, pre-hypertensive, first hypertensive, and second hypertensive, and recommend follow-ups if the result is not in the normal classification. Follow-up recommendations include increased screening intervals, lifestyle modifications, and potential interventions based on the outcome.

Failure to report Measure #317 will not result in a penalty. SLPs who provide treatment and bill 97532 and do not measure blood pressure will not be subject to penalties as long as a minimum of 50% of the patient visits for Measure #130 or Measure #131 are reported as indicated above. For more information on Measure #317, see the 2015 PQRS Individual Claims Registry Measure Specification Supporting Documents [ZIP].

Other Resources

Contact Information

CMS PQRS Help Desk (available 8:00 a.m.-8:00 p.m. Eastern)
Phone: 1-866-288-8912
E-mail: gnetsupport@sdps.org

Lisa Satterfield
Director, Health Care Regulatory Advocacy
American Speech-Language-Hearing Association
E-mail: lsatterfield@asha.org

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