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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 one "cross-cutting measure" for a minimum of 50% of the eligible Medicare patient visits in order to avoid future penalties. However, speech-language pathologists (SLPs) do not have nine measures they are eligible to report; therefore, SLPs must report on all three measures that are available. They are:

Note: SLPs who provides services to less than 15 Medicare beneficiaries in the calendar year are exempt from reporting.

In order to avoid a 2% penalty in 2018, a minimum of 50% of eligible Medicare claims must include a positive action PQRS G-code. Positive action codes are indicated with **.

Filling Out the Claim Form 

Each measure is reportable via the CMS-1500 claim form using Current Procedural Terminology (CPT) codes and specified PQRS G-codes or CPT II codes (could require modifiers), outlined in each measure below. G-codes and CPT II codes are reported in the following areas of the claim form:

  • Box 21: ICD-9/10 codes
  • Box 24D:
    • CPT codes
    • G-codes or CPT II codes, on the lines following the CPT code for the applicable service
    • CPT II code modifier, in the modifier section on the same line as the CPT II code (as needed)
CMS also provides an example of a completed claim form in Appendix D (pg. 46) of its PQRS Implementation Guide [PDF].

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

Measure Details

Reporting Criteria
Patients 18 years or older with the following procedure codes for every billed encounter.
CPT Codes
92507, 92508, 92526, 92626, 97532
G-Codes
G8427** List of current medications (includes prescription, over the counter, herbals, vitamin/mineral/dietary [nutritional] supplements) documented by the provider, including drug name, dosage, frequency, and route
G8430 Provider documentation that patient is not eligible for medication assessment
G8428 Current medications (includes prescription, over-the-counter, herbals, vitamin/mineral/dietary [nutritional] supplements) with drug name, dosage, frequency, and route not documented by the provider, reason not specified
 Not sure how to report this measure? See ASHA's sample claim form [PDF].

Measure #131: Pain Assessment and Follow-Up

A standardized pain assessment tool must be used, which may include, but is not limited to:

  • 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)
  • Visual Analog Scale (VAS)

Measure Details

Reporting Criteria
Patients 18 years or older with the following procedure codes for every billed encounter.
CPT Codes
92507, 92508, 92526, 92626, 97532
G-Codes
G8730** Pain assessment positive and follow-up plan documented
G8731** Pain assessment negative; follow-up not required
G8442 Patient not eligible/appropriate for pain assessment (severe mental incapacity or patient in emergent situation)
G8939 Patient not eligible/appropriate for pain follow-up plan (severe mental incapacity or patient in emergent situation)
G8732 No documentation of pain assessment, reason not specified
G8509 Positive pain assessment, follow-up plan not documented, reason not specified
 Not sure how to report this measure? See ASHA's sample claim form [PDF]. 

Measure #226: Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention

Patients should be asked regarding tobacco use. If tobacco use is confirmed, SLPs should advise patients to quit and offer the flyer on Tobacco Use, Swallowing, and Communication [PDF], at a minimum.

Unlike other measures reported using G-codes, measure #226 is reported using CPT II codes that could include modifiers. If a modifier is required, it should be placed with the CPT II code in the modifier section in box 24D of the CMS-1500 claim form.

Measure Details

Reporting Criteria
Patients 18 years or older, reported a minimum of once a year when the following procedure code(s) are billed.
CPT Codes
92521, 92522, 92523, 92524
G-Codes
4004F** Patient screened for tobacco use and received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified tobacco user
1036F** Current tobacco non-user
4004F with 1P modifier Tobacco screen not performed due to emergent situation or limited life expectancy     
4004F with 8P modifier No documentation of tobacco screen or cessation counseling
 Not sure how to report this measure? See ASHA's sample claim form [PDF].

Other Resources

Contact Information

PQRS QualityNet Help Desk (available 8:00 a.m.-8:00 p.m. Eastern)
Phone: 1-866-288-8912
TTY: 1-877-715-6222
E-mail: Qnetsupport@hcqis.org

Note: To avoid security violations, do not include personal identifying information, such as a Social Security Number or TIN, in e-mail inquiries to the QualityNet Help Desk.)

American Speech-Language-Hearing Association
E-mail: reimbursement@asha.org

ASHA Corporate Partners