American Speech-Language-Hearing Association

PQRS Measures Available for SLPs to Report on Claims

Medication Management and Pain Management

SLPs can avoid a 2% penalty assessment on Medicare Part B payments in 2016 by reporting the following Physician Quality Reporting System (PQRS) measures in 2014. Each measure is reportable via the CMS-1500 claim form using Current Procedural Terminology (CPT) codes and G-codes.

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

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 2016, the measure must be reported  for 50% of the eligible Medicare Part B patient visits in the 2014 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 must 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 a clinical assessment of pain using a standardized tool for the presence and characteristics of pain, which may include location, intensity, quality, onset, and duration, and that a follow-up plan for positive findings is documented.

The standardized assessment tool must be appropriately normalized and validated for the population in which it is used. The follow-up plan must include a proposed outline of treatment, including a planned reassessment of pain, education, referrals, pharmacological intervention, or notification to other health care provider(s) as necessary.

This measure should not be reported by SLPs who are not familiar with or do not regularly use standardized pain assessments in their clinical practices.

To avoid the 2% payment reduction in 2016, the measure must be reported on 50% of the eligible Medicare Part B patient visits for the 2014 calendar year, including the use of a standardized tool(s) on each visit and documentation of a follow-up plan when pain is present.

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].

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
lsatterfield@asha.org

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