CMS Provides Patient Information and Tips on Use of Modifiers with PQRI Quality Data Codes
The Centers for Medicare and Medicaid Services (CMS) has posted a "Letter to Medicare Beneficiaries" with important information about the Physician Quality Reporting Initiative (PQRI) on the CMS website. The letter is from Medicare to the patient explaining what the program is, and the implications for the patient. Physicians may choose to provide a copy of the letter for their patients in support of their PQRI participation, should there be billing questions from the patient. The letter is available in two versions, English (Adobe PDF, 73K) and Spanish (Adobe PDF, 84K).
Secondly, CMS indicates that the PQRI quality data codes should only be reported with CPT II modifier 1P, 2P, 3P or 8P, if applicable. Any other modifier, such as CPT I modifier or HCPCS Level II modifier, that is placed on the same line as a PQRI code, may cause the claim to be rejected or denied as an invalid procedure/modifier combination.
Joel Harder, Director of Quality Improvement and Outcomes, can be reached at (202) 464-3489 or jharder@HRSonline.org for questions.
