Most Frequently Asked
PQRI Questions & Answers

Q. Can professionals at FQHCs and RHCs participate?

A. No. FQHCs and RHCs do not bill under the Physician Fee Schedule.

Q. Can professionals at CAHs billing Method II, SNFs using consolidated billing, or Outpatient Facilities billing FIs participate in PQRI?

A. No. There is no way to identify the individual professionals under these billing methods to complete the analysis of successful reporting and bonus payment calculations required by the statute.

Q. Can CPT Category II quality codes be submitted separately from claims for payment?

A. No. Quality codes must be submitted on the same claim as the ICD-9 and CPT Category I codes because the analysis of satisfactory reporting requires that both the numerator and denominator codes be present.