Measures Codes

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

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

2013 Physician Quality Reporting System

2013 PQRS CMS-1500 Claim Example  

A detailed example of an Individual NPI reporting on a single CMS-1500 claim for 2013 PQRS is shown in the document titled "2013 PQRS CMS-1500 Claim Example" in the "Downloads" section below.

The following documents pertaining to the 2013 PQRS are available in the "Related Links" section below in the zip file titled "2013 PQRS Measure List and Implementation Guide":

• 2013 Physician Quality Reporting System (PQRS) Implementation Guide.  This document provides guidance about how to select measures for reporting, how to read and understand a measure specification, and outlines the reporting methods/options available for 2013 PQRS. The Implementation Guide also details how to implement claims-based reporting of measures to facilitate satisfactory reporting of quality-data codes by eligible professionals.

• 2013 Physician Quality Reporting System (PQRS) Measures List.  This document identifies and describes the measures used in PQRS, including all available reporting methods/options, corresponding PQRS number and NQF number, plus measure developers and their contact information.

The following documents pertaining to the 2013 PQRS individual measures are available in the "Related Links" section below titled "2013 PQRS Individual Claims Registry Measure Specification Support Documents":

• 2013 Physician Quality Reporting System (PQRS) Measure Specifications Manual for Claims and Registry Reporting of Individual Measures. The 2013 measure specifications include codes and reporting instructions for the 2013 PQRS measures for claims and/or registry-based reporting.

• 2013 Physician Quality Reporting System (PQRS) Measure Specification Release Notes. This document outlines 2013 updates made to the 2012 (PQRS) Measures Specifications Manual in the form of release notes.

• 2013 Physician Quality Reporting System (PQRS) Quality-Data Code (QDC) Categories.  A table that outlines, for each claims and registry 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 document identifies how each code will be used when CMS calculates performance rates. The QDC categories table also clarifies those measures that require 2 or more QDCs to report satisfactorily. Insufficiently reporting the QDCs (as specified in the 2013 PQRS measure specifications) will result as invalid reporting.

• 2013 Physician Quality Reporting System (PQRS) Single Source Code Master. This file includes a numerical listing of all codes (denominator and numerator) included in 2013 PQRS Individual Claims and Registry Measures for incorporation into billing software.

*UPDATE! This file has been temporarily moved to the "Downloads" on this page until the broken link issue is resolved. The following documents pertaining to the 2013 Physician Quality Reporting System measures groups are available in the "Downloads" section below titled "2013 PQRS Measure Groups Specifications, Release Notes, Getting Started with 2013 PQRS Measures Groups, 2013 Quality-Data Code Categories, and 2013 PQRS Measures Groups Single Source Code Master":

• 2013 Physician Quality Reporting System (PQRS) 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 2013 measures groups specifications include codes and reporting instructions for the 22 PQRS measures groups for claims or registry-based reporting.

• 2013 Physician Quality Reporting System (PQRS) Measures Groups Release Notes.  This document outlines 2013 updates made to the 2012 PQRS Measures Groups Specifications Manual in the form of release notes.

•2013 Physician Quality Reporting System (PQRS) Getting Started with Measures Groups. This document provides guidance about how to select measures groups for reporting, and how to read and understand a measure group specification in order to satisfactorily report.

• 2013 Physician Quality Reporting System (PQRS) 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 identifies how each code will be used when calculating performance rates. This also clarifies those measures that require two or more QDCs to report satisfactorily. Insufficiently reporting the QDCs (as specified in the 2013 PQRS) will result as invalid reporting. NOTE: Measures groups specifications may differ from their individual measures counterpart. This document will define the differences between the QDCs for individual and measure group specifications.

• 2013 Physician Quality Reporting System (PQRS) Measures Groups Single Source Code Master. This file includes a numerical listing of all codes included in 2013 PQRS Measures Groups for incorporation into billing software.

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.