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Are you Reporting PQRI? These specialties are!

What this graphic illustrates: The table below ranks the Top 5 specialties by rate of reporting CPT Category II Codes. The rate is calculated as Total Medicare Claims with at least 1 CPT Category II Code / Total Medicare Claims. The timeframe for this data sampling of Medicare claims was July 2009 through January 2010.


CPT Category II Codes – These are optional CPT codes that can be reported on your claim to provide quality or performance measurements. An example would be code 3038F which is “Pulmonary function test performed within 12 months prior to surgery”. See the AMA or CMS websites for more information.

PQRI – Physician Quality Reporting Initiative. The CMS project to incent healthcare providers to report quality and performance measurements.

What this means to you: Currently, Medicare provides an incentive of 2% (fiscal year 2010) for Medicare Allowed Charges for those physicians who choose to participate in the reporting of performance measures. However, the future of PQRI reporting will require physicians to report all performance measures or risk being penalized for not doing so. The graph below is intended to provide you with an understanding of the level of today’s PQRI reporting. It is recommended that you compare these utilization number to that of your practice to ensure that you are (1) benefiting from the current incentives and (2) preparing yourselves for the future changes.

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