New! Status Update regarding CPT II Coding Issue for the 2009 PQRI

CMS has identified a technical problem affecting twenty (20) quality-data codes (QDCs) used for reporting thirteen (13) quality measures through the claims-based method for 2009 PQRI. For further information and guidance regarding this issue, please see the "Status Update on CPT II Coding Issue for the 2009 PQRI and Options for Eligible Professionals (EPs)" document in the "Downloads" section below.

2009 PQRI 

This page contains information about PQRI quality measures, their specifications and related release notes, an implementation guide for reporting individual measures through claims or registry-based reporting, measures groups specifications and a related guide to implementing measures groups.

2009 PQRI Individual Quality Measures

2009 PQRI Measures List. This document, which identifies the 153 quality measures selected for the 2009 PQRI, is available in the "Downloads" section below.

2009 PQRI Quality Measures Specifications Manual and Release Notes. This zip file, which is available in the "Downloads" section below, contains two documents. These documents are the authoritative documents that describe 1) the 2009 measure specifications (including codes and reporting instructions) for the 153 individual PQRI quality measures for claims or registry-based reporting and 2) the changes from the 2008 PQRI Measure Specifications (in the form of release notes delineated by measure number).

2009 PQRI Implementation Guide. Guidance about how to implement 2009 PQRI claims-based reporting of measures to facilitate satisfactory reporting of quality data codes by eligible professionals for the 2009 PQRI is available in the "2009 PQRI Implementation Guide" under the "Downloads" section below.

2009 PQRI Measures Groups

PQRI measures can be reported for seven (7) measures groups in 2009. Measures groups were created for specific conditions that are addressed by at least 4 measures that share a common denominator specification: Diabetes Mellitus, Chronic Kidney Disease, Preventive Care, Coronary Artery Bypass Graft Surgery, Rheumatoid Arthritis, Perioperative Care, and Back Pain.

2009 PQRI Measures Groups Specifications Manual and Release Notes. Measure 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 "2009 PQRI Measures Groups Specifications Manual and Release Notes" are available as a zip file under the "Downloads" section below.

Getting Started with 2009 PQRI Reporting of Measures Groups. This document, which is available in the "Downloads" section below, is a guide to implementing the 2009 PQRI measures groups.

New! Measures Group CMS-1500 Claim Example. This updated document, which is available in the "Downloads" section below, provides a detailed sample of an individual NPI reporting one of the 2009 PQRI measures groups on a related CMS-1500 claim.

PQRI EHR Measure Specifications

The Measure Specifications for the submission of ten (10) PQRI measures through an Electronic Health Record (EHR) system are available on the QualityNet website. To access these specifications, click on the link in the "Related Links Outside CMS" section below. Once on the QualityNet website, click on "PQRI" from the drop-down menu under the "Physician Offices" tab and then click on "EHR Specifications," from the left navigation bar.  Please note that EHR-based submission of these ten measures will not be accepted for 2009 PQRI incentive payment purposes, as they are made available only for the purpose of testing submission via an EHR.  Data Submission Specifications based on the HL7 (Health Level Seven) QRDA (Quality Reporting Documentation Architecture) draft standard for trial use are now posted on the QualityNet website. 

2008 PQRI 

2008 PQRI Measure Specifications. The 119 quality measures, including 2 structural measures, specified for 2008 PQRI were published by the Centers for Medicare & Medicaid Services in the Medicare Physician Fee Schedule (PFS) 2008 Final Rule on November 1, 2007. A zip file, "2008 PQRI Quality Measures," containing the 1) 2008 PQRI Quality Measures List, 2) 2008 PQRI Quality Measure Specifications, and 3) 2008 PQRI Quality Measures Release Notes, Version 1.2 is available in the "Downloads" section below.

2008 Test Measure Set

From July 1, 2008, through September 30, 2008, CMS accepted data submission on Part B Professional Services claims for eleven (11) new quality measures for the purpose of testing to determine their inclusion in future PQRI measure sets. There is no financial incentive payment nor feedback report associated with the submission of these test measures. 

2008 PQRI Test Measures. This zip file, found in the "Downloads" section below, contains the 2008 PQRI test measure specifications and their corresponding release notes.

Downloads
Status Update on CPT II Coding Issue for the 2009 PQRI and Options for Eligible Professionals (EPs) [PDF, 34KB] 2009 PQRI Quality Measures List [PDF, 549 KB] 2009 PQRI Quality Measure Specifications Manual and Release Notes [ZIP 1MB] 2009 PQRI Implementation Guide [PDF 404 KB] 2009 PQRI Measures Groups Specifications Manual and Release Notes [ZIP 395 KB] Getting Started with 2009 PQRI Reporting of Measures Groups [PDF 144 KB] Measures Group CMS-1500 Claim Example. [PDF 785 KB] 2008 PQRI Quality Measures [ZIP 2MB] 2008 PQRI Test Measures [ZIP 137KB]
Related Links Inside CMS
PQRI FAQS All Measures and Codes FAQS
Related Links Outside CMS
Quality Net Website