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pdf2013 Physician Quality Reporting System (PQRS)
Measures List
11/16/2012
Date: 11/16/2012
Version 7.1
Page 1 of 44
2013 PQRS Measures List
The Physician Quality Reporting System (PQRS) measures were developed by various organizations for 2013. The following is a list of each measure’s NQF
number, PQRS number, developer, and available reporting method. Contact information for specific measure developers is available on the last page of the 2013
PQRS Measures List. Questions regarding the construct of a measure or its intent should be referred to the measure developer/contact as outlined in Appendix II
(on page 44). Please note that gaps in the PQRS measure numbering reflects measures retired from prior PQRS program years. Please reference the List of
Retired PQRS Measure Specifications for specific information regarding measures’ year of retirement from PQRS. This table is contained within the 2013 PQRS
Measure Specifications Manual for Claims and Registry Reporting of Individual Measures at the following link: http://www.cms.gov/Medicare/Quality-InitiativesPatient-Assessment-Instruments/PQRS/MeasuresCodes.html.
This measure list is intended as a summary list to assist eligible professionals initially reviewing the measures and should not be used as a replacement for the
measure specifications, which contain detailed reporting and coding instructions. A list of PQRS Measure Specifications by reporting method may be found in
Appendix I (on page 43).
NQF PQRS
#
#
0059
1
GPRO
DM-2
0064
0061
0081
Date: 11/16/2012
Version 7.1
National
Quality
Strategy
Domain
Clinical
Process/
Effectiveness
2
Clinical
Process/
Effectiveness
3
Clinical
Process/
Effectiveness
5
Clinical
Process/
Effectiveness
Measure
Descriptiona
Diabetes Mellitus: Hemoglobin A1c Poor Control: Percentage of patients aged 18
through 75 years with diabetes mellitus who had most recent hemoglobin A1c
greater than 9.0%
Diabetes Mellitus: Low Density Lipoprotein (LDL-C) Control: Percentage of
patients aged 18 through 75 years with diabetes mellitus who had most recent LDL-C
level in control (less than 100 mg/dL)
Diabetes Mellitus: High Blood Pressure Control: Percentage of patients aged 18
through 75 years with diabetes mellitus who had most recent blood pressure in
control (less than 140/90 mmHg)
Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin
Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction
(LVSD): Percentage of patients aged 18 years and older with a diagnosis of heart
failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who
were prescribed ACE inhibitor or ARB therapy either within a 12 month period when
seen in the outpatient setting OR at each hospital discharge
Measure
Developer
NCQA
NCQA
NCQA
AMAPCPI/ACCF/
AHA
Reporting
Options
Claims, Registryb,
EHR, GPRO/ACOc,
DM Measures Group
(C/R)
Claims, Registry,
EHR, DM Measures
Group (C/R),
Cardiovascular
Prevention Measures
Group (C/R)
Claims, Registry,
EHR, DM Measures
Group (C/R)
Registry, EHR, HF
Measures Group (R)
Page 2 of 44
2013 PQRS Measures List
NQF PQRS
#
#
National
Quality
Strategy
Domain
6
Clinical
Process/
Effectiveness
0070
7
Clinical
Process/
Effectiveness
0083
8
GPRO
HF-6
Clinical
Process/
Effectiveness
0105
9
Clinical
Process/
Effectiveness
0086
12
Clinical
Process/
Effectiveness
0087
14
Clinical
Process/
Effectiveness
0067
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Coronary Artery Disease (CAD): Antiplatelet Therapy: Percentage of patients
aged 18 years and older with a diagnosis of coronary artery disease seen within a 12
month period who were prescribed aspirin or clopidogrel
Coronary Artery Disease (CAD): Beta-Blocker Therapy - Prior Myocardial
Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF < 40%):
Percentage of patients aged 18 years and older with a diagnosis of coronary artery
disease seen within a 12 month period who also have prior MI OR a current or prior
left ventricular ejection fraction (LVEF) < 40% who were prescribed beta-blocker
therapy
Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction
(LVSD): Percentage of patients aged 18 years and older with a diagnosis of heart
failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who
were prescribed beta-blocker therapy either within a 12 month period when seen in
the outpatient setting OR at each hospital discharge
Major Depressive Disorder (MDD): Antidepressant Medication During Acute
Phase for Patients with MDD: Percentage of patients aged 18 years and older
diagnosed with new episode of MDD and documented as treated with antidepressant
medication during the entire 84-day (12-week) acute treatment phase
Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation: Percentage of
patients aged 18 years and older with a diagnosis of primary open-angle glaucoma
who have an optic nerve head evaluation during one or more office visits within 12
months
Age-Related Macular Degeneration (AMD): Dilated Macular Examination:
Percentage of patients aged 50 years and older with a diagnosis of AMD who had a
dilated macular examination performed which included documentation of the
presence or absence of macular thickening or hemorrhage AND the level of macular
degeneration severity during one or more office visits within 12 months
Measure
Developer
Reporting
Options
AMAPCPI/ACCF/
AHA
Claims, Registry,
EHR, CAD Measures
Group (R)
AMAPCPI/ACCF/
AHA
AMAPCPI/ACCF/
AHA
Registry, EHR
Registry, EHR,
GPRO/ACO, HF
Measures Group (R)
NCQA
Claims, Registry,
EHR
AMAPCPI/NCQA
Claims, Registry,
EHR
AMAPCPI/NCQA
Claims, Registry
Page 3 of 44
2013 PQRS Measures List
NQF PQRS
#
#
National
Quality
Strategy
Domain
0088
18
Clinical
Process/
Effectiveness
0089
19
Clinical
Process/
Effectiveness
0270
20
Patient Safety
0268
21
Patient Safety
0271
22
Patient Safety
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Diabetic Retinopathy: Documentation of Presence or Absence of Macular
Edema and Level of Severity of Retinopathy: Percentage of patients aged 18
years and older with a diagnosis of diabetic retinopathy who had a dilated macular or
fundus exam performed which included documentation of the level of severity of
retinopathy and the presence or absence of macular edema during one or more
office visits within 12 months
Diabetic Retinopathy: Communication with the Physician Managing Ongoing
Diabetes Care: Percentage of patients aged 18 years and older with a diagnosis of
diabetic retinopathy who had a dilated macular or fundus exam performed with
documented communication to the physician who manages the ongoing care of the
patient with diabetes mellitus regarding the findings of the macular or fundus exam at
least once within 12 months
Perioperative Care: Timing of Prophylactic Parenteral Antibiotic – Ordering
Physician: Percentage of surgical patients aged 18 years and older undergoing
procedures with the indications for prophylactic parenteral antibiotics, who have an
order for prophylactic parenteral antibiotic to be given within one hour (if
fluoroquinolone or vancomycin, two hours), prior to the surgical incision (or start of
procedure when no incision is required)
Perioperative Care: Selection of Prophylactic Antibiotic – First OR Second
Generation Cephalosporin: Percentage of surgical patients aged 18 years and
older undergoing procedures with the indications for a first OR second generation
cephalosporin prophylactic antibiotic, who had an order for cefazolin OR cefuroxime
for antimicrobial prophylaxis
Perioperative Care: Discontinuation of Prophylactic Parenteral Antibiotics
(Non-Cardiac Procedures): Percentage of non-cardiac surgical patients aged 18
years and older undergoing procedures with the indications for prophylactic
parenteral antibiotics AND who received a prophylactic parenteral antibiotic, who
have an order for discontinuation of prophylactic parenteral antibiotics within 24
hours of surgical end time
Measure
Developer
Reporting
Options
AMAPCPI/NCQA
Claims, Registry,
EHR
AMAPCPI/NCQA
Claims, Registry,
EHR
AMAPCPI/NCQA
Claims, Registry,
Periop Measures
Group (C/R)
AMAPCPI/NCQA
Claims, Registry,
Periop Measures
Group (C/R)
AMAPCPI/NCQA
Claims, Registry,
Periop Measures
Group (C/R)
Page 4 of 44
2013 PQRS Measures List
NQF PQRS
#
#
National
Quality
Strategy
Domain
0239
23
Patient Safety
0045
24
Care
Coordination
0092
28
Clinical
Process/
Effectiveness
0269
30
Patient Safety
0240
31
Clinical
Process/
Effectiveness
0325
32
Clinical
Process/
Effectiveness
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When
Indicated in ALL Patients): Percentage of surgical patients aged 18 years and older
undergoing procedures for which VTE prophylaxis is indicated in all patients, who
had an order for Low Molecular Weight Heparin (LMWH), Low-Dose Unfractionated
Heparin (LDUH), adjusted-dose warfarin, fondaparinux or mechanical prophylaxis to
be given within 24 hours prior to incision time or within 24 hours after surgery end
time
Osteoporosis: Communication with the Physician Managing On-going Care
Post-Fracture of Hip, Spine or Distal Radius for Men and Women Aged 50
Years and Older: Percentage of patients aged 50 years and older treated for a hip,
spine or distal radial fracture with documentation of communication with the
physician managing the patient’s on-going care that a fracture occurred and that the
patient was or should be tested or treated for osteoporosis
Aspirin at Arrival for Acute Myocardial Infarction (AMI): Percentage of patients,
regardless of age, with an emergency department discharge diagnosis of AMI who
had documentation of receiving aspirin within 24 hours before emergency
department arrival or during emergency department stay
Perioperative Care: Timely Administration of Prophylactic Parenteral
Antibiotics: Percentage of surgical patients aged 18 years and older who receive an
anesthetic when undergoing procedures with the indications for prophylactic
parenteral antibiotics for whom administration of the prophylactic parenteral antibiotic
ordered has been initiated within one hour (if fluoroquinolone or vancomycin, two
hours) prior to the surgical incision (or start of procedure when no incision is
required)
Stroke and Stroke Rehabilitation: Deep Vein Thrombosis (DVT) Prophylaxis for
Ischemic Stroke or Intracranial Hemorrhage: Percentage of patients aged 18
years and older with a diagnosis of ischemic stroke or intracranial hemorrhage who
were administered DVT prophylaxis by end of hospital day two
Stroke and Stroke Rehabilitation: Discharged on Antithrombotic Therapy:
Percentage of patients aged 18 years and older with a diagnosis of ischemic stroke
or transient ischemic attack (TIA) who were prescribed antithrombotic therapy at
discharge
Measure
Developer
Reporting
Options
AMAPCPI/NCQA
Claims, Registry,
Periop Measures
Group (C/R)
AMAPCPI/NCQA
Claims, Registry
AMAPCPI/NCQA
Claims, Registry
AMAPCPI/NCQA
Claims, Registry
AMAPCPI/NCQA
Claims, Registry
AMAPCPI/NCQA
Claims, Registry
Page 5 of 44
2013 PQRS Measures List
NQF PQRS
#
#
National
Quality
Strategy
Domain
0241
33
Clinical
Process/
Effectiveness
0243
35
Clinical
Process/
Effectiveness
0244
36
Clinical
Process/
Effectiveness
0046
39
Clinical
Process/
Effectiveness
0048
40
Clinical
Process/
Effectiveness
0049
41
0134
43
Date: 11/16/2012
Version 7.1
Clinical
Process/
Effectiveness
Clinical
Process/
Effectiveness
Measure
Descriptiona
Stroke and Stroke Rehabilitation: Anticoagulant Therapy Prescribed for Atrial
Fibrillation (AF) at Discharge: Percentage of patients aged 18 years and older with
a diagnosis of ischemic stroke or transient ischemic attack (TIA) with documented
permanent, persistent, or paroxysmal atrial fibrillation who were prescribed an
anticoagulant at discharge
Stroke and Stroke Rehabilitation: Screening for Dysphagia: Percentage of
patients aged 18 years and older with a diagnosis of ischemic stroke or intracranial
hemorrhage who receive any food, fluids or medication by mouth (PO) for whom a
dysphagia screening was performed prior to PO intake in accordance with a
dysphagia screening tool approved by the institution in which the patient is receiving
care
Stroke and Stroke Rehabilitation: Rehabilitation Services Ordered: Percentage
of patients aged 18 years and older with a diagnosis of ischemic stroke or intracranial
hemorrhage for whom occupational, physical, or speech rehabilitation services were
ordered at or prior to inpatient discharge OR documentation that no rehabilitation
services are indicated at or prior to inpatient discharge
Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older:
Percentage of female patients aged 65 years and older who have a central dualenergy X-ray absorptiometry (DXA) measurement ordered or performed at least once
since age 60 or pharmacologic therapy prescribed within 12 months
Osteoporosis: Management Following Fracture of Hip, Spine or Distal Radius
for Men and Women Aged 50 Years and Older: Percentage of patients aged 50
years and older with fracture of the hip, spine, or distal radius who had a central
dual-energy X-ray absorptiometry (DXA) measurement ordered or performed or
pharmacologic therapy prescribed
Osteoporosis: Pharmacologic Therapy for Men and Women Aged 50 Years and
Older: Percentage of patients aged 50 years and older with a diagnosis of
osteoporosis who were prescribed pharmacologic therapy within 12 months
Coronary Artery Bypass Graft (CABG): Use of Internal Mammary Artery (IMA)
in Patients with Isolated CABG Surgery: Percentage of patients aged 18 years
and older undergoing isolated CABG surgery who received an IMA graft
Measure
Developer
Reporting
Options
AMAPCPI/NCQA
Registry
AMAPCPI/NCQA
Claims, Registry
AMAPCPI/NCQA
Claims, Registry
AMAPCPI/NCQA
Claims, Registry,
EHR, Prev Care
Measures Group
(C/R)
AMAPCPI/NCQA
Claims, Registry
AMAPCPI/NCQA
Claims, Registry
STS
Claims, Registry,
CABG Measures
Group (R)
Page 6 of 44
2013 PQRS Measures List
NQF PQRS
#
#
National
Quality
Strategy
Domain
0236
44
Clinical
Process/
Effectiveness
0637
45
Patient Safety
0097
46
GPRO
CARE-1
Patient Safety
0326
47
Care
Coordination
48
Clinical
Process/
Effectiveness
0098
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Coronary Artery Bypass Graft (CABG): Preoperative Beta-Blocker in Patients
with Isolated CABG Surgery: Percentage of isolated Coronary Artery Bypass Graft
(CABG) surgeries for patients aged 18 years and older who received a beta-blocker
within 24 hours prior to surgical incision
Perioperative Care: Discontinuation of Prophylactic Parenteral Antibiotics
(Cardiac Procedures): Percentage of cardiac surgical patients aged 18 years and
older undergoing procedures with the indications for prophylactic parenteral
antibiotics AND who received a prophylactic parenteral antibiotic, who have an order
for discontinuation of prophylactic parenteral antibiotics within 48 hours of surgical
end time
Medication Reconciliation: Percentage of patients aged 65 years and older
discharged from any inpatient facility (e.g., hospital, skilled nursing facility, or
rehabilitation facility) and seen within 30 days following discharge in the office by
the physician providing on-going care who had a reconciliation of the discharge
medications with the current medication list in the outpatient medical record
documented
Advance Care Plan: Percentage of patients aged 65 years and older who have an
advance care plan or surrogate decision maker documented in the medical record or
documentation in the medical record that an advance care plan was discussed but
the patient did not wish or was not able to name a surrogate decision maker or
provide an advance care plan
Urinary Incontinence: Assessment of Presence or Absence of Urinary
Incontinence in Women Aged 65 Years and Older: Percentage of female patients
aged 65 years and older who were assessed for the presence or absence of urinary
incontinence within 12 months
Measure
Developer
Reporting
Options
CMS/QIP
Claims, Registry,
CABG Measures
Group (R)
AMAPCPI/NCQA
Claims, Registry
AMAPCPI/NCQA
Claims, Registry,
GPRO/ACO
AMAPCPI/NCQA
Claims, Registry,
EHR
AMAPCPI/NCQA
Claims, Registry,
EHR, Prev Care
Measures Group
(C/R)
Page 7 of 44
2013 PQRS Measures List
NQF PQRS
#
#
National
Quality
Strategy
Domain
49
Clinical
Process/
Effectiveness
0100
50
Patient and
Family
Engagement
0091
51
Clinical
Process/
Effectiveness
0102
52
Clinical
Process/
Effectiveness
0047
53
Clinical
Process/
Effectiveness
0090
54
Clinical
Process/
Effectiveness
0099
0093
55
0232
56
Date: 11/16/2012
Version 7.1
Clinical
Process/
Effectiveness
Clinical
Process/
Effectiveness
Measure
Descriptiona
Urinary Incontinence: Characterization of Urinary Incontinence in Women Aged
65 Years and Older: Percentage of female patients aged 65 years and older with a
diagnosis of urinary incontinence whose urinary incontinence was characterized at
least once within 12 months
Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65
Years and Older: Percentage of female patients aged 65 years and older with a
diagnosis of urinary incontinence with a documented plan of care for urinary
incontinence at least once within 12 months
Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation:
Percentage of patients aged 18 years and older with a diagnosis of COPD who had
spirometry evaluation results documented
Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy:
Percentage of patients aged 18 years and older with a diagnosis of COPD and who
have an FEV1/FVC less than 60% and have symptoms who were prescribed an
inhaled bronchodilator
Asthma: Pharmacologic Therapy for Persistent Asthma - Ambulatory Care
Setting: Percentage of patients aged 5 through 50 years with a diagnosis of
persistent asthma and at least one medical encounter for asthma during the
measurement year who were prescribed long-term control medication
Emergency Medicine: 12-Lead Electrocardiogram (ECG) Performed for NonTraumatic Chest Pain: Percentage of patients aged 40 years and older with an
emergency department discharge diagnosis of non-traumatic chest pain who had a
12-lead ECG performed
Emergency Medicine: 12-Lead Electrocardiogram (ECG) Performed for
Syncope: Percentage of patients aged 60 years and older with an emergency
department discharge diagnosis of syncope who had a 12-lead ECG performed
Emergency Medicine: Community-Acquired Pneumonia (CAP): Vital Signs:
Percentage of patients aged 18 years and older with a diagnosis of communityacquired bacterial pneumonia with vital signs documented and reviewed
Measure
Developer
Reporting
Options
AMAPCPI/NCQA
Claims, Registry
AMAPCPI/NCQA
Claims, Registry
AMAPCPI
Claims, Registry,
COPD Measures
Group (C/R)
AMAPCPI
Claims, Registry,
COPD Measures
Group (C/R)
AMAPCPI/NCQA
Claims, Registry,
EHR, Asthma
Measures Group
(C/R)
AMAPCPI/NCQA
Claims, Registry
AMAPCPI/NCQA
Claims, Registry
AMAPCPI/NCQA
Claims, Registry
Page 8 of 44
2013 PQRS Measures List
NQF PQRS
#
#
National
Quality
Strategy
Domain
59
Clinical
Process/
Effectiveness
0001
64
Clinical
Process/
Effectiveness
0069
65
Efficient Use
of Healthcare
Resources
0002
66
Efficient Use
of Healthcare
Resources
0377
67
Clinical
Process/
Effectiveness
0378
68
Clinical
Process/
Effectiveness
0380
69
Clinical
Process/
Effectiveness
0096
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Emergency Medicine: Community-Acquired Pneumonia (CAP): Empiric
Antibiotic: Percentage of patients aged 18 years and older with a diagnosis of
community-acquired bacterial pneumonia with an appropriate empiric antibiotic
prescribed
Asthma: Assessment of Asthma Control – Ambulatory Care Setting:
Percentage of patients aged 5 through 50 years with a diagnosis of asthma who
were evaluated at least once for asthma control (comprising asthma impairment and
asthma risk)
Appropriate Treatment for Children with Upper Respiratory Infection (URI):
Percentage of children aged 3 months through 18 years with a diagnosis of URI who
were not prescribed or dispensed an antibiotic prescription on or within 3 days of
the initial date of service
Appropriate Testing for Children with Pharyngitis: Percentage of children aged 2
through 18 years with a diagnosis of pharyngitis, who were prescribed an antibiotic
and who received a group A streptococcus (strep) test for the episode. A higher rate
represents better performance (i.e. appropriate testing).
Hematology: Myelodysplastic Syndrome (MDS) and Acute Leukemias: Baseline
Cytogenetic Testing Performed on Bone Marrow: Percentage of patients aged 18
years and older with a diagnosis of MDS or an acute leukemia who had baseline
cytogenetic testing performed on bone marrow
Hematology: Myelodysplastic Syndrome (MDS): Documentation of Iron Stores
in Patients Receiving Erythropoietin Therapy: Percentage of patients aged 18
years and older with a diagnosis of MDS who are receiving erythropoietin therapy
with documentation of iron stores within 60 days prior to initiating erythropoietin
therapy
Hematology: Multiple Myeloma: Treatment with Bisphosphonates: Percentage
of patients aged 18 years and older with a diagnosis of multiple myeloma, not in
remission, who were prescribed or received intravenous bisphosphonate therapy
within the 12-month reporting period
Measure
Developer
Reporting
Options
AMAPCPI/NCQA
Claims, Registry
AMAPCPI/NCQA
Claims, Registry,
EHR, Asthma
Measures Group
(C/R)
NCQA
Claims, Registry
NCQA
Claims, Registry,
EHR
AMAPCPI/ASH
Claims, Registry
AMAPCPI/ASH
Claims, Registry
AMAPCPI/ASH
Claims, Registry
Page 9 of 44
2013 PQRS Measures List
NQF PQRS
#
#
National
Quality
Strategy
Domain
0379
70
Clinical
Process/
Effectiveness
0387
71
Clinical
Process/
Effectiveness
0385
72
Clinical
Process/
Effectiveness
0464
76
Patient Safety
0323
81
Care
Coordination
0321
82
Care
Coordination
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Hematology: Chronic Lymphocytic Leukemia (CLL): Baseline Flow Cytometry:
Percentage of patients aged 18 years and older seen within a 12 month reporting
period with a diagnosis of chronic lymphocytic leukemia (CLL) made at any time
during or prior to the reporting period who had baseline flow cytometry studies
performed and documented in the chart
Breast Cancer: Hormonal Therapy for Stage IC - IIIC Estrogen
Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer: Percentage of
female patients aged 18 years and older with Stage IC through IIIC, ER or PR
positive breast cancer who were prescribed tamoxifen or aromatase inhibitor (AI)
during the 12-month reporting period
Colon Cancer: Chemotherapy for AJCC Stage III Colon Cancer Patients:
Percentage of patients aged 18 through 80 years with AJCC Stage III colon cancer
who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy, or
have previously received adjuvant chemotherapy within the 12-month reporting
period
Prevention of Catheter-Related Bloodstream Infections (CRBSI): Central
Venous Catheter (CVC) Insertion Protocol: Percentage of patients, regardless of
age, who undergo CVC insertion for whom CVC was inserted with all elements of
maximal sterile barrier technique [cap AND mask AND sterile gown AND sterile
gloves AND a large sterile sheet AND hand hygiene AND 2% chlorhexidine for
cutaneous antisepsis (or acceptable alternative antiseptics per current guideline)]
followed
Adult Kidney Disease: Hemodialysis Adequacy: Solute: Percentage of calendar
months within a 12-month period during which patients aged 18 years and older with
DGLDJQRVLVRI(65'UHFHLYLQJKHPRGLDO\VLVWKUHHWLPHVDZHHNIRU GD\VZKR
KDYHDVS.W9
Adult Kidney Disease: Peritoneal Dialysis Adequacy: Solute: Percentage of
patients aged 18 years and older with a diagnosis of ESRD receiving peritoneal
GLDO\VLVZKRKDYHDWRWDO.W91.7 per week measured once every 4 months
Measure
Developer
Reporting
Options
AMAPCPI/ASH
Claims, Registry
AMAPCPI/
ASCO/NCCN
Claims, Registry,
EHR, Oncology
Measures Group (R)
AMAPCPI/
ASCO/NCCN
Claims, Registry,
EHR, Oncology
Measures Group (R)
AMAPCPI
Claims, Registry
AMAPCPI
Registry
AMAPCPI
Registry
Page 10 of 44
2013 PQRS Measures List
NQF PQRS
#
#
National
Quality
Strategy
Domain
83
Clinical
Process/
Effectiveness
0395
84
Clinical
Process/
Effectiveness
0396
85
Clinical
Process/
Effectiveness
0397
86
Clinical
Process/
Effectiveness
0398
87
Clinical
Process/
Effectiveness
0401
89
Clinical
Process/
Effectiveness
0394
90
Clinical
Process/
Effectiveness
0653
91
Clinical
Process/
Effectiveness
0393
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Hepatitis C: Testing for Chronic Hepatitis C – Confirmation of Hepatitis C
Viremia: Percentage of patients aged 18 years and older with a diagnosis of
hepatitis C seen for an initial evaluation who had HCV RNA testing ordered or
previously performed
Hepatitis C: Ribonucleic Acid (RNA) Testing Before Initiating Treatment:
Percentage of patients aged 18 years and older with a diagnosis of chronic hepatitis
C who are receiving antiviral treatment for whom quantitative HCV RNA testing was
performed within 6 months prior to initiation of antiviral treatment
Hepatitis C: HCV Genotype Testing Prior to Treatment: Percentage of patients
aged 18 years and older with a diagnosis of chronic hepatitis C who are receiving
antiviral treatment for whom HCV genotype testing was performed prior to initiation of
antiviral treatment
Hepatitis C: Antiviral Treatment Prescribed: Percentage of patients aged 18 years
and older with a diagnosis of chronic hepatitis C who were prescribed at a minimum
peginterferon and ribavirin therapy within the 12-month reporting period
Hepatitis C: HCV Ribonucleic Acid (RNA) Testing at Week 12 of Treatment:
Percentage of patients aged 18 years and older with a diagnosis of chronic hepatitis
C who are receiving antiviral treatment for whom quantitative HCV RNA testing was
performed at no greater than 12 weeks from the initiation of antiviral treatment
Hepatitis C: Counseling Regarding Risk of Alcohol Consumption: Percentage of
patients aged 18 years and older with a diagnosis of hepatitis C who were counseled
about the risks of alcohol use at least once within 12-months
Hepatitis C: Counseling Regarding Use of Contraception Prior to Antiviral
Therapy: Percentage of female patients aged 18 through 44 years and all men aged
18 years and older with a diagnosis of chronic hepatitis C who are receiving antiviral
treatment who were counseled regarding contraception prior to the initiation of
treatment
Acute Otitis Externa (AOE): Topical Therapy: Percentage of patients aged 2 years
and older with a diagnosis of AOE who were prescribed topical preparations
Measure
Developer
Reporting
Options
AMAPCPI
Registry
AMAPCPI
Claims, Registry, Hep
C Measures Group
(C/R)
AMAPCPI
Claims, Registry, Hep
C Measures Group
(C/R)
AMAPCPI
Claims, Registry, Hep
C Measures Group
(C/R)
AMAPCPI
Claims, Registry, Hep
C Measures Group
(C/R)
AMAPCPI
Claims, Registry, Hep
C Measures Group
(C/R)
AMAPCPI
Claims, Registry, Hep
C Measures Group
(C/R)
AMAPCPI
Claims, Registry
Page 11 of 44
2013 PQRS Measures List
NQF PQRS
#
#
National
Quality
Strategy
Domain
0654
93
Care
Coordination
0391
99
Clinical
Process/
Effectiveness
0392
100
Clinical
Process/
Effectiveness
0389
102
Efficient Use
of Healthcare
Resources
0390
104
Clinical
Process/
Effectiveness
0103
106
Clinical
Process/
Effectiveness
0104
107
Clinical
Process/
Effectiveness
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy – Avoidance of
Inappropriate Use: Percentage of patients aged 2 years and older with a diagnosis
of AOE who were not prescribed systemic antimicrobial therapy
Breast Cancer Resection Pathology Reporting: pT Category (Primary Tumor)
and pN Category (Regional Lymph Nodes) with Histologic Grade: Percentage of
breast cancer resection pathology reports that include the pT category (primary
tumor), the pN category (regional lymph nodes), and the histologic grade
Colorectal Cancer Resection Pathology Reporting: pT Category (Primary
Tumor) and pN Category (Regional Lymph Nodes) with Histologic Grade:
Percentage of colon and rectum cancer resection pathology reports that include the
pT category (primary tumor), the pN category (regional lymph nodes) and the
histologic grade
Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk
Prostate Cancer Patients: Percentage of patients, regardless of age, with a
diagnosis of prostate cancer at low risk of recurrence receiving interstitial prostate
brachytherapy, OR external beam radiotherapy to the prostate, OR radical
prostatectomy, OR cryotherapy who did not have a bone scan performed at any time
since diagnosis of prostate cancer
Prostate Cancer: Adjuvant Hormonal Therapy for High Risk Prostate Cancer
Patients: Percentage of patients, regardless of age, with a diagnosis of prostate
cancer at high risk of recurrence receiving external beam radiotherapy to the prostate
who were prescribed adjuvant hormonal therapy (GnRH agonist or antagonist)
Adult Major Depressive Disorder (MDD): Comprehensive Depression
Evaluation: Diagnosis and Severity: Percentage of patients aged 18 years and
older with a diagnosis of major depressive disorder (MDD) with evidence that they
met the DSM-IV-TR criteria for MDD AND for whom there is an assessment of
depression severity during the visit in which a new diagnosis or recurrent episode
was identified
Adult Major Depressive Disorder (MDD): Suicide Risk Assessment: Percentage
of patients aged 18 years and older with a diagnosis of major depressive disorder
(MDD) with a suicide risk assessment completed during the visit in which a new
diagnosis or recurrent episode was identified
Measure
Developer
Reporting
Options
AMAPCPI
Claims, Registry
AMAPCPI/CAP
Claims, Registry
AMAPCPI/CAP
Claims, Registry
AMAPCPI
Claims, Registry,
EHR
AMAPCPI
Claims, Registry
AMAPCPI
Claims, Registry
AMAPCPI
Claims, Registry
Page 12 of 44
2013 PQRS Measures List
NQF PQRS
#
#
National
Quality
Strategy
Domain
0054
108
Clinical
Process/
Effectiveness
0050
109
Patient and
Family
Engagement
0041
110
GPRO
PREV-7
Population/
Public Health
0043
111
GPRO
PREV-8
Clinical
Process/
Effectiveness
0031
112
GPRO
PREV-5
Clinical
Process/
Effectiveness
0034
113
GPRO
PREV-6
Clinical
Process/
Effectiveness
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Rheumatoid Arthritis (RA): Disease Modifying Anti-Rheumatic Drug (DMARD)
Therapy: Percentage of patients aged 18 years and older who were diagnosed with
RA and were prescribed, dispensed, or administered at least one ambulatory
prescription for a DMARD
Osteoarthritis (OA): Function and Pain Assessment: Percentage of patient visits
for patients aged 21 years and older with a diagnosis of OA with assessment for
function and pain
Preventive Care and Screening: Influenza Immunization: Percentage of patients
aged 6 months and older seen for a visit between October 1 and March 31 who
received an influenza immunization OR who reported previous receipt of an influenza
immunization
Preventive Care and Screening: Pneumococcal Vaccination for Patients 65
Years and Older: Percentage of patients aged 65 years and older who have ever
received a pneumococcal vaccine
Measure
Developer
Reporting
Options
NCQA
Claims, Registry, RA
Measures Group
(C/R)
AMAPCPI
Claims, Registry
AMAPCPI
NCQA
Preventive Care and Screening: Breast Cancer Screening: Percentage of women
aged 40 through 69 years who had a mammogram to screen for breast cancer within
24 months
NCQA
Preventive Care and Screening: Colorectal Cancer Screening: Percentage of
patients aged 50 through 75 years who received the appropriate colorectal cancer
screening
NCQA
Claims, Registry,
EHR, GPRO/ACO,
COPD Measures
Group (C/R), Prev
Care Measures
Group (C/R), CKD
Measures Group
(C/R), Oncology
Measures Group (R)
Claims, Registry,
EHR, GPRO/ACO,
COPD Measures
Group (C/R), Prev
Care Measures
Group (C/R)
Claims, Registry,
EHR, GPRO/ACO,
Prev Care Measures
Group (C/R)
Claims, Registry,
EHR, GPRO/ACO,
Prev Care Measures
Group (C/R)
Page 13 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
0058
116
Efficient Use
of Healthcare
Resources
0055
117
Clinical
Process/
Effectiveness
0066
118
GPRO
CAD-7
Clinical
Process/
Effectiveness
0062
119
Clinical
Process/
Effectiveness
AQA
adopted
121
Clinical
Process/
Effectiveness
AQA
adopted
122
Clinical
Process/
Effectiveness
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Antibiotic Treatment for Adults with Acute Bronchitis: Avoidance of
Inappropriate Use: Percentage of adults aged 18 through 64 years with a
diagnosis of acute bronchitis who were not prescribed or dispensed an antibiotic
prescription on or within 3 days of the initial date of service
Diabetes Mellitus: Dilated Eye Exam: Percentage of patients aged 18 through 75
years with a diagnosis of diabetes mellitus who had a dilated eye exam
Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE)
Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy - Diabetes or Left
Ventricular Systolic Dysfunction (LVEF < 40%): Percentage of patients aged 18
years and older with a diagnosis of coronary artery disease seen within a 12 month
period who also have diabetes OR a current or prior Left Ventricular Ejection
Fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB therapy
Diabetes Mellitus: Medical Attention for Nephropathy: Percentage of patients
aged 18 through 75 years with diabetes mellitus who received urine protein
screening or medical attention for nephropathy during at least one office visit within
12 months
Adult Kidney Disease: Laboratory Testing (Lipid Profile): Percentage of
patients aged 18 years and older with a diagnosis of CKD (stage 3, 4, or 5, not
receiving Renal Replacement Therapy [RRT]) who had a fasting lipid profile
performed at least once within a 12-month period
Adult Kidney Disease: Blood Pressure Management: Percentage of patient
visits for those patients aged 18 years and older with a diagnosis of CKD (stage 3,
4, or 5, not receiving Renal Replacement Therapy [RRT]) and documented
proteinuria with a blood pressXUH PP+J25PP+JZLWKD
documented plan of care
Measure
Developer
Reporting
Options
NCQA
Claims, Registry
NCQA
Claims, Registry,
EHR, DM Measures
Group (C/R)
AMAPCPI/ACCF/
AHA
Registry, GPRO/ACO
NCQA
Claims, Registry,
EHR, DM Measures
Group (C/R)
AMAPCPI
Claims, Registry,
CKD Measures Group
(C/R)
AMAPCPI
Claims, Registry,
CKD Measures Group
(C/R)
Page 14 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
AQA
adopted
123
Clinical
Process/
Effectiveness
0486
125
Care
Coordination/
Patient Safety
0417
126
Clinical
Process/
Effectiveness
0416
127
Clinical
Process/
Effectiveness
0421
128
GPRO
PREV-9
Population/
Public Health
0419
130
Patient Safety
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Adult Kidney Disease: Patients On Erythropoiesis-Stimulating Agent (ESA) Hemoglobin Level > 12.0 g/dL: Percentage of calendar months within a 12-month
period during which a hemoglobin level is measured for patients aged 18 years and
older with a diagnosis of advanced Chronic Kidney Disease (CKD) (stage 4 or 5, not
receiving RRT [Renal Replacement Therapy]) or End Stage Renal Disease (ESRD)
(who are on hemodialysis or peritoneal dialysis) who are also receiving ESA therapy
AND have a Hemoglobin level > 12.0 g/dL
Refer to the Electronic Prescribing (eRx) Incentive Program
Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy –
Neurological Evaluation: Percentage of patients aged 18 years and older with a
diagnosis of diabetes mellitus who had a neurological examination of their lower
extremities within 12 months
Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention –
Evaluation of Footwear: Percentage of patients aged 18 years and older with a
diagnosis of diabetes mellitus who were evaluated for proper footwear and sizing
Preventive Care and Screening: Body Mass Index (BMI) Screening and
Follow-Up: Percentage of patients aged 18 years and older with a calculated BMI
in the past six months or during the current visit documented in the medical record
AND if the most recent BMI is outside of normal parameters, a follow-up plan is
documented within the past six months or during the current visit
Normal Parameters: $JH\HDUVDQGROGHU%0,DQG $JH– 64
\HDUV%0,DQG
Documentation of Current Medications in the Medical Record: Percentage of
specified visits for patients aged 18 years and older for which the eligible
professional attests to documenting a list of current medications to the best of
his/her knowledge and ability. This list must include ALL prescriptions, over-thecounters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must
contain the medications’ name, dosage, frequency and route of administration
Measure
Developer
Reporting
Options
AMAPCPI
Claims, Registry,
CKD Measures Group
(C/R)
CMS/QIP
Claims, Registry,
EHR, GPRO/ACO
APMA
Claims, Registry
APMA
Claims, Registry
CMS/QIP
Claims, Registry,
EHR, GPRO/ACO,
Prev Care Measures
Group (C/R)
CMS/QIP
Claims, Registry,
Oncology Measure
Group (R)
Page 15 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
0420
131
Population/
Public Health
0418
134
GPRO
PREV12
Population/
Public Health
0650
137
Clinical
Process/
Effectiveness
0561
138
Care
Coordination
0566
140
Clinical
Process/
Effectiveness
0563
141
Care
Coordination
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Pain Assessment and Follow-Up: Percentage of visits for patients aged 18 years
and older with documentation of a pain assessment through discussion with the
patient including the use of a standardized tool(s) on each visit AND documentation
of a follow-up plan when pain is present
Preventive Care and Screening: Screening for Clinical Depression and FollowUp Plan: Percentage of patients aged 12 years and older screened for clinical
depression on the date of encounter using an age appropriate standardized
depression screening tool AND, if positive, a follow-up plan is documented on the
date of the positive screen
Melanoma: Continuity of Care – Recall System: Percentage of patients,
regardless of age, with a current diagnosis of melanoma or a history of melanoma
whose information was entered, at least once within a 12 month period, into a recall
system that includes:
• A target date for the next complete physical skin exam, AND
• A process to follow up with patients who either did not make an appointment within
the specified timeframe or who missed a scheduled appointment
Melanoma: Coordination of Care: Percentage of patient visits, regardless of age,
with a new occurrence of melanoma who have a treatment plan documented in the
chart that was communicated to the physician(s) providing continuing care within
one month of diagnosis
Age-Related Macular Degeneration (AMD): Counseling on Antioxidant
Supplement: Percentage of patients aged 50 years and older with a diagnosis of
age-related macular degeneration or their caregiver(s) who were counseled within
12 months on the benefits and/or risks of the Age-Related Eye Disease Study
(AREDS) formulation for preventing progression of AMD
Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure
(IOP) by 15% OR Documentation of a Plan of Care: Percentage of patients aged
18 years and older with a diagnosis of primary open-angle glaucoma whose
glaucoma treatment has not failed (the most recent IOP was reduced by at least
15% from the pre- intervention level) OR if the most recent IOP was not reduced by
at least 15% from the pre- intervention level, a plan of care was documented within
12 months
Measure
Developer
Reporting
Options
CMS/QIP
Claims, Registry
CMS/QIP
Claims, Registry,
GPRO/ACO
AMAPCPI/NCQA
Registry
AMAPCPI/NCQA
Registry
AMAPCPI/NCQA
Claims, Registry
AMAPCPI/NCQA
Claims, Registry
Page 16 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
0051
142
Clinical
Process/
Effectiveness
0384
143
Patient and
Family
Engagement
0383
144
Patient and
Family
Engagement
0510
145
Patient Safety
0508
146
Efficient Use
of Healthcare
Resources
0511
147
Care
Coordination
0322
148
0319
149
Date: 11/16/2012
Version 7.1
Efficient Use
of Healthcare
Resources
Clinical
Process/
Effectiveness
Measure
Descriptiona
Osteoarthritis (OA): Assessment for Use of Anti-Inflammatory or Analgesic
Over-the-Counter (OTC) Medications: Percentage of patient visits for patients
aged 21 years and older with a diagnosis of OA with an assessment for use of antiinflammatory or analgesic OTC medications
Oncology: Medical and Radiation – Pain Intensity Quantified: Percentage of
patient visits, regardless of patient age, with a diagnosis of cancer currently
receiving chemotherapy or radiation therapy in which pain intensity is quantified
Oncology: Medical and Radiation – Plan of Care for Pain: Percentage of visits
for patients, regardless of age, with a diagnosis of cancer currently receiving
chemotherapy or radiation therapy who report having pain with a documented plan
of care to address pain
Radiology: Exposure Time Reported for Procedures Using Fluoroscopy:
Percentage of final reports for procedures using fluoroscopy that include
documentation of radiation exposure or exposure time
Radiology: Inappropriate Use of “Probably Benign” Assessment Category in
Mammography Screening: Percentage of final reports for screening
mammograms that are classified as “probably benign”
Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients
Undergoing Bone Scintigraphy: Percentage of final reports for all patients,
regardless of age, undergoing bone scintigraphy that include physician
documentation of correlation with existing relevant imaging studies (e.g., x-ray, MRI,
CT, etc.) that were performed
Back Pain: Initial Visit: The percentage of patients aged 18 through 79 years with
a diagnosis of back pain or undergoing back surgery who had back pain and
function assessed during the initial visit to the clinician for the episode of back pain
Back Pain: Physical Exam: Percentage of patients aged 18 through 79 years with
a diagnosis of back pain or undergoing back surgery who received a physical
examination at the initial visit to the clinician for the episode of back pain
Measure
Developer
Reporting
Options
AMAPCPI
Claims, Registry
AMAPCPI
Registry, Oncology
Measures Group (R)
AMAPCPI
Registry, Oncology
Measures Group (R)
AMAPCPI/NCQA
Claims, Registry
AMAPCPI/NCQA
Claims, Registry
AMAPCPI
Claims, Registry
NCQA
Back Pain Measures
Group (C/R)
NCQA
Back Pain Measures
Group (C/R)
Page 17 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
150
Clinical
Process/
Effectiveness
0313
151
Clinical
Process/
Effectiveness
0101
154
Patient Safety
0101
155
Care
Coordination
0382
156
Patient Safety
0455
157
Patient Safety
0404
159
Clinical
Process/
Effectiveness
0405
160
Clinical
Process/
Effectiveness
0314
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Back Pain: Advice for Normal Activities: The percentage of patients aged 18
through 79 years with a diagnosis of back pain or undergoing back surgery who
received advice for normal activities at the initial visit to the clinician for the episode
of back pain
Back Pain: Advice Against Bed Rest: The percentage of patients aged 18
through 79 years with a diagnosis of back pain or undergoing back surgery who
received advice against bed rest lasting four days or longer at the initial visit to the
clinician for the episode of back pain
Falls: Risk Assessment: Percentage of patients aged 65 years and older with a
history of falls who had a risk assessment for falls completed within 12 months
Falls: Plan of Care: Percentage of patients aged 65 years and older with a history
of falls who had a plan of care for falls documented within 12 months
Oncology: Radiation Dose Limits to Normal Tissues: Percentage of patients,
regardless of age, with a diagnosis of pancreatic or lung cancer receiving 3D
conformal radiation therapy with documentation in medical record that radiation
dose limits to normal tissues were established prior to the initiation of a course of
3D conformal radiation for a minimum of two tissues
Thoracic Surgery: Recording of Clinical Stage Prior to Lung Cancer or
Esophageal Cancer Resection: Percentage of surgical patients aged 18 years
and older undergoing resection for lung or esophageal cancer who had clinical
staging provided prior to surgery
HIV/AIDS: CD4+ Cell Count or CD4+ Percentage: Percentage of patients aged 6
months and older with a diagnosis of HIV/AIDS for whom a CD4+ cell count or
CD4+ cell percentage was performed at least once every 6 months
HIV/AIDS: Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis: Percentage
of patients aged 6 years and older with a diagnosis of HIV/AIDS and CD4+ cell
count < 200 cells/mm3 who were prescribed PCP prophylaxis within 3 months of low
CD4+ cell count
Measure
Developer
Reporting
Options
NCQA
Back Pain Measures
Group (C/R)
NCQA
Back Pain Measures
Group (C/R)
AMAPCPI/NCQA
AMAPCPI/NCQA
Claims, Registry
Claims, Registry
AMAPCPI
Claims, Registry
STS
Claims, Registry
AMAPCPI/NCQA
Registry, HIV/AIDS
Measures Group (R)
AMAPCPI/NCQA
Registry, HIV/AIDS
Measures Group (R)
Page 18 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
0406
161
Clinical
Process/
Effectiveness
0407
162
Clinical
Process/
Effectiveness
0056
163
0129
164
0130
165
Clinical
Process/
Effectiveness
0131
166
Clinical
Process/
Effectiveness
167
Clinical
Process/
Effectiveness
0114
Date: 11/16/2012
Version 7.1
Clinical
Process/
Effectiveness
Clinical
Process/
Effectiveness
Measure
Descriptiona
HIV/AIDS: Adolescent and Adult Patients with HIV/AIDS Who Are Prescribed
Potent Antiretroviral Therapy: Percentage of patients with a diagnosis of
HIV/AIDS aged 13 years and older: who have a history of a nadir CD4+ cell count
below 350/mm3 or who have a history of an AIDS- defining condition, regardless of
CD4+ cell count; or who are pregnant, regardless of CD4+ cell count or age, who
were prescribed potent antiretroviral therapy
HIV/AIDS: HIV RNA Control After Six Months of Potent Antiretroviral Therapy:
Percentage of patients aged 13 years and older with a diagnosis of HIV/AIDS who
are receiving potent antiretroviral therapy, who have a viral load below limits of
quantification after at least 6 months of potent antiretroviral therapy or patients
whose viral load is not below limits of quantification after at least 6 months of potent
antiretroviral therapy and have documentation of a plan of care
Diabetes Mellitus: Foot Exam: The percentage of patients aged 18 through 75
years with diabetes who had a foot examination
Coronary Artery Bypass Graft (CABG): Prolonged Intubation: Percentage of
patients aged 18 years and older undergoing isolated CABG surgery who require
intubation > 24 hours
Coronary Artery Bypass Graft (CABG): Deep Sternal Wound Infection Rate:
Percentage of patients aged 18 years and older undergoing isolated CABG surgery
who, within 30 days postoperatively, develop deep sternal wound infection involving
muscle, bone, and/or mediastinum requiring operative intervention
Coronary Artery Bypass Graft (CABG): Stroke: Percentage of patients aged 18
years and older undergoing isolated CABG surgery who have a postoperative
stroke (i.e., any confirmed neurological deficit of abrupt onset caused by a
disturbance in blood supply to the brain) that did not resolve within 24 hours
Coronary Artery Bypass Graft (CABG): Postoperative Renal Failure:
Percentage of patients aged 18 years and older undergoing isolated CABG surgery
(without pre-existing renal failure) who develop postoperative renal failure or require
dialysis
Measure
Developer
Reporting
Options
AMAPCPI/NCQA
Registry, HIV/AIDS
Measures Group (R)
AMAPCPI/NCQA
Registry, HIV/AIDS
Measures Group (R)
NCQA
Claims, Registry,
EHR, DM Measures
Group (C/R)
STS
Registry, CABG
Measures Group (R)
STS
Registry, CABG
Measures Group (R)
STS
Registry, CABG
Measures Group (R)
STS
Registry, CABG
Measures Group (R)
Page 19 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
Clinical
Process/
Effectiveness
0115
168
0116
169
0117
170
0118
171
0259
172
Clinical
Process/
Effectiveness
173
Population/
Public Health
AQA
adopted
Clinical
Process/
Effectiveness
Clinical
Process/
Effectiveness
Clinical
Process/
Effectiveness
AQA
adopted
176
Clinical
Process/
Effectiveness
AQA
adopted
177
Clinical
Process/
Effectiveness
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Coronary Artery Bypass Graft (CABG): Surgical Re-Exploration: Percentage of
patients aged 18 years and older undergoing isolated CABG surgery who require a
return to the operating room (OR) during the current hospitalization for mediastinal
bleeding with or without tamponade, graft occlusion, valve dysfunction, or other
cardiac reason
Coronary Artery Bypass Graft (CABG): Antiplatelet Medications at Discharge:
Percentage of patients aged 18 years and older undergoing isolated CABG surgery
who were discharged on antiplatelet medication
Coronary Artery Bypass Graft (CABG): Beta-Blockers Administered at
Discharge: Percentage of patients aged 18 years and older undergoing isolated
CABG surgery who were discharged on beta-blockers
Coronary Artery Bypass Graft (CABG): Anti-Lipid Treatment at Discharge:
Percentage of patients aged 18 years and older undergoing isolated CABG surgery
who were discharged on a statin or other lipid-lowering regimen
Hemodialysis Vascular Access Decision-Making by Surgeon to Maximize
Placement of Autogenous Arterial Venous (AV) Fistula: Percentage of patients
aged 18 years and older with a diagnosis of advanced Chronic Kidney Disease
(CKD) (stage 4 or 5) or End Stage Renal Disease (ESRD) requiring hemodialysis
vascular access documented by surgeon to have received autogenous AV fistula
Preventive Care and Screening: Unhealthy Alcohol Use – Screening:
Percentage of patients aged 18 years and older who were screened for unhealthy
alcohol use using a systematic screening method within 24 months
Rheumatoid Arthritis (RA): Tuberculosis Screening: Percentage of patients
aged 18 years and older with a diagnosis of RA who have documentation of a
tuberculosis (TB) screening performed and results interpreted within 6 months prior
to receiving a first course of therapy using a biologic disease-modifying antirheumatic drug (DMARD)
Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity:
Percentage of patients aged 18 years and older with a diagnosis of RA who have an
assessment and classification of disease activity within 12 months
Measure
Developer
Reporting
Options
STS
Registry, CABG
Measures Group (R)
STS
Registry, CABG
Measures Group (R)
STS
Registry, CABG
Measures Group (R)
STS
Registry, CABG
Measures Group (R)
SVS
Claims, Registry
AMAPCPI
Claims, Registry,
EHR, Prev Care
Measures Group
(C/R)
AMAPCPI/NCQA
Claims, Registry, RA
Measures Group
(C/R)
AMAPCPI/NCQA
Claims, Registry, RA
Measures Group
(C/R)
Page 20 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
AQA
adopted
178
Clinical
Process/
Effectiveness
AQA
adopted
179
Clinical
Process/
Effectiveness
AQA
adopted
180
Care
Coordination
AQA
adopted
181
Patient Safety
AQA
adopted
182
Care
Coordination
0399
183
Population/
Public Health
0400
184
Population/
Public Health
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Rheumatoid Arthritis (RA): Functional Status Assessment: Percentage of
patients aged 18 years and older with a diagnosis of RA for whom a functional
status assessment was performed at least once within 12 months
Rheumatoid Arthritis (RA): Assessment and Classification of Disease
Prognosis: Percentage of patients aged 18 years and older with a diagnosis of RA
who have an assessment and classification of disease prognosis at least once
within 12 months
Rheumatoid Arthritis (RA): Glucocorticoid Management: Percentage of patients
aged 18 years and older with a diagnosis of RA who have been assessed for
JOXFRFRUWLFRLGXVHDQGIRUWKRVHRQSURORQJHGGRVHVRISUHGQLVRQHPJGDLO\
(or equivalent) with improvement or no change in disease activity, documentation of
glucocorticoid management plan within 12 months
Elder Maltreatment Screen and Follow-Up Plan: Percentage of patients aged 65
years and older with a documented elder maltreatment screen on the date of
encounter AND a documented follow-up plan on the date of positive screen
Functional Outcome Assessment: Percentage of visits for patients aged 18 years
and older with documentation of a current functional outcome assessment using a
standardized functional outcome assessment tool on the date of the encounter AND
documentation of a care plan based on identified functional outcome deficiencies on
the date of the identified deficiencies
Hepatitis C: Hepatitis A Vaccination in Patients with HCV: Percentage of
patients aged 18 years and older with a diagnosis of hepatitis C who received at
least one injection of hepatitis A vaccine, or who have documented immunity to
hepatitis A
Hepatitis C: Hepatitis B Vaccination in Patients with HCV: Percentage of
patients aged 18 years and older with a diagnosis of hepatitis C who received at
least one injection of hepatitis B vaccine, or who have documented immunity to
hepatitis B
Measure
Developer
Reporting
Options
AMAPCPI/NCQA
Claims, Registry, RA
Measures Group
(C/R)
AMAPCPI/NCQA
Claims, Registry, RA
Measures Group
(C/R)
AMAPCPI/NCQA
Claims, Registry, RA
Measures Group
(C/R)
CMS/QIP
Claims, Registry
CMS/QIP
Claims, Registry
AMAPCPI
Claims, Registry, Hep
C Measures Group
(C/R)
AMAPCPI
Claims, Registry, Hep
C Measures Group
(C/R)
Page 21 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
0659
185
Care
Coordination
0437
187
Clinical
Process/
Effectiveness
N/A
188.
Care
Coordination
0565
191
Clinical
Process/
Effectiveness
0564
192
Patient Safety
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Endoscopy & Polyp Surveillance: Colonoscopy Interval for Patients with a
History of Adenomatous Polyps – Avoidance of Inappropriate Use: Percentage
of patients aged 18 years and older receiving a surveillance colonoscopy with a
history of a prior colonic polyp(s) in previous colonoscopy findings, who had an
interval of 3 or more years since their last colonoscopy
Stroke and Stroke Rehabilitation: Thrombolytic Therapy: Percentage of patients
aged 18 years and older with a diagnosis of acute ischemic stroke who arrive at the
hospital within two hours of time last known well and for whom IV t-PA was initiated
within three hours of time last known well
Referral for Otologic Evaluation for Patients with Congenital or Traumatic
Deformity of the Ear: Percentage of patients aged birth and older referred to a
physician (preferably a physician with training in disorders of the ear) for an otologic
evaluation subsequent to an audiologic evaluation after presenting with a congenital
or traumatic deformity of the ear (internal or external)
Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract
Surgery: Percentage of patients aged 18 years and older with a diagnosis of
uncomplicated cataract who had cataract surgery and no significant ocular
conditions impacting the visual outcome of surgery and had best-corrected visual
acuity of 20/40 or better (distance or near) achieved within 90 days following the
cataract surgery
Cataracts: Complications within 30 Days Following Cataract Surgery
Requiring Additional Surgical Procedures: Percentage of patients aged 18 years
and older with a diagnosis of uncomplicated cataract who had cataract surgery and
had any of a specified list of surgical procedures in the 30 days following cataract
surgery which would indicate the occurrence of any of the following major
complications: retained nuclear fragments, endophthalmitis, dislocated or wrong
power IOL, retinal detachment, or wound dehiscence
Measure
Developer
Reporting
Options
AMAPCPI/NCQA
Claims, Registry
AHA/ASA/
TJC
Registry
AQC
Claims, Registry
AMAPCPI/NCQA
Registry, Cataract
Measures Group (R)
AMAPCPI/NCQA
Registry, Cataract
Measures Group (R)
Page 22 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
0454
193
Patient Safety
0386
194
Clinical
Process/
Effectiveness
0507
195
Clinical
Process/
Effectiveness
0074
197
GPRO
CAD-2
Clinical
Process/
Effectiveness
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Perioperative Temperature Management: Percentage of patients, regardless of
age, undergoing surgical or therapeutic procedures under general or neuraxial
anesthesia of 60 minutes duration or longer, except patients undergoing
cardiopulmonary bypass, for whom either active warming was used intraoperatively
for the purpose of maintaining normothermia, OR at least one body temperature
equal to or greater than 36 degrees Centigrade (or 96.8 degrees Fahrenheit) was
recorded within the 30 minutes immediately before or the 15 minutes immediately
after anesthesia end time
Oncology: Cancer Stage Documented: Percentage of patients, regardless of age,
with a diagnosis of cancer who are seen in the ambulatory setting who have a
baseline AJCC cancer stage or documentation that the cancer is metastatic in the
medical record at least once within 12 months
Radiology: Stenosis Measurement in Carotid Imaging Reports: Percentage of
final reports for carotid imaging studies (neck magnetic resonance angiography
[MRA], neck computed tomography angiography [CTA], neck duplex ultrasound,
carotid angiogram) performed that include direct or indirect reference to
measurements of distal internal carotid diameter as the denominator for stenosis
measurement
Coronary Artery Disease (CAD): Lipid Control: Percentage of patients aged 18
years and older with a diagnosis of coronary artery disease seen within a 12 month
period who have a LDL-C result < 100 mg/dL OR patients who have a LDL-C result
PJG/DQGKave a documented plan of care to achieve LDL-C <100 mg/dL,
including at a minimum the prescription of a statin
Measure
Developer
AMAPCPI
Reporting
Options
Claims, Registry
AMAA
PCPI/ASCO
Claims, Registry,
Oncology Measure
Group (R)
AMAPCPI/NCQA
Claims, Registry
AMAPCPI/ACCF/
AHA
Registry, EHR,
GPRO/ACO, CAD
Measures Group (R)
Page 23 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
0079
198
0084
200
National
Quality
Strategy
Domain
Clinical
Process/
Effectiveness
Clinical
Process/
Effectiveness
Clinical
Process/
Effectiveness
0073
201
0068
204
GPRO
IVD-2
Clinical
Process/
Effectiveness
0409
205
Clinical
Process/
Effectiveness
0410
208
Clinical
Process/
Effectiveness
0445
209
Clinical
Process/
Effectiveness
0449
210
Clinical
Process/
Effectiveness
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Heart Failure: Left Ventricular Ejection Fraction (LVEF) Assessment:
Percentage of patients aged 18 years and older with a diagnosis of heart failure for
whom the quantitative or qualitative results of a recent or prior [any time in the past]
LVEF assessment is documented within a 12 month period
Heart Failure: Warfarin Therapy for Patients with Atrial Fibrillation: Percentage
of all patients aged 18 and older with a diagnosis of heart failure and paroxysmal or
chronic atrial fibrillation who were prescribed warfarin therapy
Ischemic Vascular Disease (IVD): Blood Pressure Management: Percentage of
patients aged 18 to 75 years with Ischemic Vascular Disease (IVD) who had most
recent blood pressure in control (less than 140/90 mmHg)
Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic:
Percentage of patients aged 18 years and older with Ischemic Vascular Disease
(IVD) with documented use of aspirin or another antithrombotic
HIV/AIDS: Sexually Transmitted Disease Screening for Chlamydia and
Gonorrhea: Percentage of patients aged 13 years and older with a diagnosis of
HIV/AIDS for whom chlamydia and gonorrhea screenings were performed at least
once since the diagnosis of HIV infection
HIV/AIDS: Sexually Transmitted Disease Screening for Syphilis: Percentage of
patients aged 13 years and older with a diagnosis of HIV/AIDS who were screened
for syphilis at least once within 12 months
Functional Communication Measure - Spoken Language Comprehension:
Percentage of patients aged 16 years and older with a diagnosis of late effects of
cerebrovascular disease (CVD) that make progress on the Spoken Language
Comprehension Functional Communication Measure
Functional Communication Measure - Attention: Percentage of patients aged 16
years and older with a diagnosis of late effects of cerebrovascular disease (CVD)
that make progress on the Attention Functional Communication Measure
Measure
Developer
Reporting
Options
AMAPCPI/ACCF/
AHA
AMAPCPI/ACCF/A
HA
Registry, HF
Measures Group (R)
NCQA
NCQA
EHR
Claims, Registry,
EHR, IVD Measures
Group (C/R)
Claims, Registry,
EHR, GPRO/ACO,
IVD Measures Group
(C/R), Cardiovascular
Prevention Measures
Group (C/R)
AMAPCPI/NCQA
Registry, HIV/AIDS
Measures Group (R)
AMAPCPI/NCQA
Registry, HIV/AIDS
Measures Group (R)
ASHA
Registry
ASHA
Registry
Page 24 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
0448
211
Clinical
Process/
Effectiveness
0447
212
Clinical
Process/
Effectiveness
0446
213
Clinical
Process/
Effectiveness
0444
214
Clinical
Process/
Effectiveness
0442
215
0443
216
0422
217
Care
Coordination
0423
218
Care
Coordination
Date: 11/16/2012
Version 7.1
Clinical
Process/
Effectiveness
Clinical
Process/
Effectiveness
Measure
Descriptiona
Functional Communication Measure - Memory: Percentage of patients aged 16
years and older with a diagnosis of late effects of cerebrovascular disease (CVD)
that make progress on the Memory Functional Communication Measure
Functional Communication Measure - Motor Speech: Percentage of patients
aged 16 years and older with a diagnosis of late effects of cerebrovascular disease
(CVD) that make progress on the Motor Speech Functional Communication
Measure
Functional Communication Measure - Reading: Percentage of patients aged 16
years and older with a diagnosis of late effects of cerebrovascular disease (CVD)
that make progress on the Reading Functional Communication Measure
Functional Communication Measure - Spoken Language Expression:
Percentage of patients aged 16 years and older with a diagnosis of late effects of
cerebrovascular disease (CVD) that make progress on the Spoken Language
Expression Functional Communication Measure
Functional Communication Measure - Writing: Percentage of patients aged 16
years and older with a diagnosis of late effects of cerebrovascular disease (CVD)
that make progress on the Writing Functional Communication Measure
Functional Communication Measure - Swallowing: Percentage of patients aged
16 years and older with a diagnosis of late effects of cerebrovascular disease (CVD)
that make progress on the Swallowing Functional Communication Measure
Functional Deficit: Change in Risk-Adjusted Functional Status for Patients
with Knee Impairments: Percentage of patients aged 18 or older that receive
treatment for a functional deficit secondary to a diagnosis that affects the knee in
which the change in their Risk-Adjusted Functional Status is measured
Functional Deficit: Change in Risk-Adjusted Functional Status for Patients
with Hip Impairments: Percentage of patients aged 18 or older that receive
treatment for a functional deficit secondary to a diagnosis that affects the hip in
which the change in their Risk-Adjusted Functional Status is measured
Measure
Developer
Reporting
Options
ASHA
Registry
ASHA
Registry
ASHA
Registry
ASHA
Registry
ASHA
Registry
ASHA
Registry
FOTO
Registry
FOTO
Registry
Page 25 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
0424
219
Care
Coordination
0425
220
Care
Coordination
0426
221
Care
Coordination
0427
222
Care
Coordination
0428
223
Care
Coordination
0562
224
Efficient Use
of Healthcare
Resources
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Functional Deficit: Change in Risk-Adjusted Functional Status for Patients
with Lower Leg, Foot or Ankle Impairments: Percentage of patients aged 18 or
older that receive treatment for a functional deficit secondary to a diagnosis that
affects the lower leg, foot or ankle in which the change in their Risk-Adjusted
Functional Status is measured
Functional Deficit: Change in Risk-Adjusted Functional Status for Patients
with Lumbar Spine Impairments: Percentage of patients aged 18 or older that
receive treatment for a functional deficit secondary to a diagnosis that affects the
lumbar spine in which the change in their Risk- Adjusted Functional Status is
measured
Functional Deficit: Change in Risk-Adjusted Functional Status for Patients
with Shoulder Impairments: Percentage of patients aged 18 or older that receive
treatment for a functional deficit secondary to a diagnosis that affects the shoulder
in which the change in their Risk-Adjusted Functional Status is measured
Functional Deficit: Change in Risk-Adjusted Functional Status for Patients
with Elbow, Wrist or Hand Impairments: Percentage of patients aged 18 or older
that receive treatment for a functional deficit secondary to a diagnosis that affects
the elbow, wrist or hand in which the change in their Risk-Adjusted Functional
Status is measured
Functional Deficit: Change in Risk-Adjusted Functional Status for Patients
with Neck, Cranium, Mandible, Thoracic Spine, Ribs, or Other General
Orthopedic Impairments: Percentage of patients aged 18 or older that receive
treatment for a functional deficit secondary to a diagnosis that affects the neck,
cranium, mandible, thoracic spine, ribs, or other general orthopedic impairment in
which the change in their Risk-Adjusted Functional Status is measured
Melanoma: Overutilization of Imaging Studies in Melanoma: Percentage of
patients, regardless of age, with a current diagnosis of stage 0 through IIC
melanoma or a history of melanoma of any stage, without signs or symptoms
suggesting systemic spread, seen for an office visit during the one-year
measurement period, for whom no diagnostic imaging studies were ordered
Measure
Developer
Reporting
Options
FOTO
Registry
FOTO
Registry
FOTO
Registry
FOTO
Registry
FOTO
Registry
AMAPCPI/NCQA
Registry
Page 26 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
0509
225
National
Quality
Strategy
Domain
Care
Coordination
226
GPRO
PREV10
Population/
Public Health
N/A
228
Clinical
Process/
Effectiveness
N/A
231
Clinical
Process/
Effectiveness
0028
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Radiology: Reminder System for Mammograms: Percentage of patients aged 40
years and older undergoing a screening mammogram whose information is entered
into a reminder system with a target due date for the next mammogram
Preventive Care and Screening: Tobacco Use: Screening and Cessation
Intervention: Percentage of patients aged 18 years and older who were screened
for tobacco use one or more times within 24 months AND who received cessation
counseling intervention if identified as a tobacco user
Heart Failure (HF): Left Ventricular Function (LVF) Testing: Percentage of
patients 18 years and older with Left Ventricular Function (LVF) testing performed
within the previous 12 months for patients who are hospitalized with a principal
diagnosis of Heart Failure (HF) during the reporting period
Asthma: Tobacco Use: Screening - Ambulatory Care Setting: Percentage of
patients (or their primary caregiver) aged 5 through 50 years with a diagnosis of
asthma who were queried about tobacco use and exposure to second hand smoke
within their home environment at least once during the one-year measurement
period
Measure
Developer
Reporting
Options
AMAPCPI/NCQA
Claims, Registry
AMAPCPI
Claims, Registry,
EHR, GPRO/ACO,
CAD Measures Group
(R), COPD Measures
Group (C/R), HF
Measures Group (R),
IBD Measures Group
(R), IVD Measures
Group (C/R), Prev
Care Measures
Group (C/R),
Cardiovascular
Prevention Measures
Group (C/R),
Oncology Measure
Group (R)
CMS/QIP
Registry
AMAPCPI/NCQA
Claims, Registry,
Asthma Measures
Group (C/R)
Page 27 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
N/A
232
Clinical
Process/
Effectiveness
0457
233
Clinical
Process/
Effectiveness
0458
234
Patient Safety
0018
236
GPRO
HTN-2
Clinical
Process/
Effectiveness
0013
237
Clinical
Process/
Effectiveness
0022
238
Patient Safety
0024
239
Population/
Public Health
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Asthma: Tobacco Use: Intervention - Ambulatory Care Setting: Percentage of
patients (or their primary caregiver) aged 5 through 50 years with a diagnosis of
asthma who were identified as tobacco users (patients who currently use tobacco
AND patients who do not currently use tobacco, but are exposed to second hand
smoke in their home environment) who received tobacco cessation intervention at
least once during the one-year measurement period
Thoracic Surgery: Recording of Performance Status Prior to Lung or
Esophageal Cancer Resection: Percentage of patients aged 18 years and older
undergoing resection for lung or esophageal cancer who had performance status
documented and reviewed within 2 weeks prior to surgery
Thoracic Surgery: Pulmonary Function Tests Before Major Anatomic Lung
Resection (Pneumonectomy, Lobectomy, or Formal Segmentectomy):
Percentage of thoracic surgical patients aged 18 years and older undergoing at
least one pulmonary function test within 12 months prior to a major lung resection
(pneumonectomy, lobectomy, or formal segmentectomy)
Hypertension (HTN): Controlling High Blood Pressure: Percentage of patients
aged 18 through 85 years of age who had a diagnosis of hypertension (HTN) and
whose BP was adequately controlled (< 140/90 mmHg)
Hypertension (HTN): Blood Pressure Measurement: Percentage of patient visits
for patients aged 18 years and older with a diagnosis of hypertension with blood
pressure (BP) recorded
Drugs to be Avoided in the Elderly: Percentage of patients ages 65 years and
older who received at least one drug to be avoided in the elderly and/or two different
drugs to be avoided in the elderly in the measurement period
Weight Assessment and Counseling for Children and Adolescents:
Percentage of children 2 through 17 years of age who had an outpatient visit with a
PCP or OB/GYN and who had evidence of BMI percentile documentation,
counseling for nutrition and counseling for physical activity during the measurement
period
Measure
Developer
Reporting
Options
AMAPCPI/NCQA
Claims, Registry,
Asthma Measures
Group (C/R)
STS
Registry
STS
Registry
NCQA
Claims, Registry,
EHR, GPRO/ACO,
Cardiovascular
Prevention Measures
Group (C/R)
AMAPCPI
EHR
NCQA
EHR
NCQA
EHR
Page 28 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
0038
240
National
Quality
Strategy
Domain
Population/
Public Health
241
GPRO
IVD-1
Clinical
Process/
Effectiveness
N/A
242
Clinical
Process/
Effectiveness
0643
243
Clinical
Process/
Effectiveness
N/A
244
Clinical
Process/
Effectiveness
0075
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Childhood Immunization Status: The percentage of children two years of age
who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV);
one measles, mumps, rubella (MMR); three H influenza type B (HiB); three hepatitis
B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); two
hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by
their second birthday
Ischemic Vascular Disease (IVD): Complete Lipid Panel and Low Density
Lipoprotein (LDL-C) Control: Percentage of patients aged 18 years and older with
Ischemic Vascular Disease (IVD) who received at least one lipid profile within 12
months and whose most recent LDL-C level was in control (less than 100 mg/dL)
Coronary Artery Disease (CAD): Symptom Management: Percentage of patients
aged 18 years and older with a diagnosis of coronary artery disease seen within a
12 month period with an evaluation of level of activity and an assessment of
whether anginal symptoms are present or absent with appropriate management of
anginal symptoms within a 12 month period
Cardiac Rehabilitation Patient Referral from an Outpatient Setting: Percentage
of patients evaluated in an outpatient setting who within the previous 12 months
have experienced an acute myocardial infarction (MI), coronary artery bypass graft
(CABG) surgery, a percutaneous coronary intervention (PCI), cardiac valve surgery,
or cardiac transplantation, or who have chronic stable angina (CSA) and have not
already participated in an early outpatient cardiac rehabilitation/secondary
prevention (CR) program for the qualifying event/diagnosis who were referred to a
CR program
Hypertension: Blood Pressure Management: Percentage of patients aged 18
years and older with a diagnosis of hypertension seen within a 12 month period with
DEORRGSUHVVXUH PP+J25SDWLHQWVZLWKDEORRGSUHVVXUH
mmHg and prescribed two or more anti-hypertensive medications during the most
recent office visit
Measure
Developer
Reporting
Options
NCQA
EHR
NCQA
Claims, Registry,
EHR, GPRO/ACO,
IVD Measures Group
(C/R), Cardiovascular
Prevention Measures
Group (C/R)
AMAPCPI/ACCF/
AHA
ACCFAHA
AMAPCPI/ACCF/
AHA
Registry, CAD
Measures Group (R)
Registry
Registry
Page 29 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
AQA
adopted
245
Clinical
Process/
Effectiveness
AQA
adopted
246
Clinical
Process/
Effectiveness
AQA
adopted
247
Clinical
Process/
Effectiveness
AQA
adopted
248
Clinical
Process/
Effectiveness
N/A
249
N/A
250
N/A
251
Date: 11/16/2012
Version 7.1
Clinical
Process/
Effectiveness
Clinical
Process/
Effectiveness
Clinical
Process/
Effectiveness
Measure
Descriptiona
Chronic Wound Care: Use of Wound Surface Culture Technique in Patients
with Chronic Skin Ulcers (Overuse Measure): Percentage of patient visits for
those patients aged 18 years and older with a diagnosis of chronic skin ulcer
without the use of a wound surface culture technique
Chronic Wound Care: Use of Wet to Dry Dressings in Patients with Chronic
Skin Ulcers (Overuse Measure): Percentage of patient visits for those patients
aged 18 years and older with a diagnosis of chronic skin ulcer without a
prescription or recommendation to use wet to dry dressings
Substance Use Disorders: Counseling Regarding Psychosocial and
Pharmacologic Treatment Options for Alcohol Dependence: Percentage of
patients aged 18 years and older with a diagnosis of current alcohol dependence
who were counseled regarding psychosocial AND pharmacologic treatment options
for alcohol dependence within the 12-month reporting period
Substance Use Disorders: Screening for Depression Among Patients with
Substance Abuse or Dependence: Percentage of patients aged 18 years and
older with a diagnosis of current substance abuse or dependence who were
screened for depression within the 12-month reporting period
Barrett's Esophagus: Percentage of esophageal biopsy reports that document the
presence of Barrett’s mucosa that also include a statement about dysplasia
Radical Prostatectomy Pathology Reporting: Percentage of radical
prostatectomy pathology reports that include the pT category, the pN category, the
Gleason score and a statement about margin status
Immunohistochemical (IHC) Evaluation of Human Epidermal Growth Factor
Receptor 2 Testing (HER2) for Breast Cancer Patients: This is a measure based
on whether quantitative evaluation of Human Epidermal Growth Factor Receptor 2
Testing (HER2) by immunohistochemistry (IHC) uses the system recommended in
the ASCO/CAP Guidelines for Human Epidermal Growth Factor Receptor 2 Testing
in breast cancer
Measure
Developer
Reporting
Options
AMAPCPI/NCQA
Claims, Registry
AMAPCPI/NCQA
Claims, Registry
AMAPCPI/NCQA
Claims, Registry
AMAPCPI/NCQA
Claims, Registry
CAP
Claims, Registry
CAP
Claims, Registry
CAP
Claims, Registry
Page 30 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
0503
252
Clinical
Process/
Effectiveness
0651
254
Clinical
Process/
Effectiveness
0652
255
Clinical
Process/
Effectiveness
N/A
256
Care
Coordination
N/A
257
Clinical
Process/
Effectiveness
N/A
258
Care
Coordination
N/A
259
Care
Coordination
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Anticoagulation for Acute Pulmonary Embolus Patients: Anticoagulation
ordered for patients who have been discharged from the emergency department
(ED) with a diagnosis of acute pulmonary embolus
Ultrasound Determination of Pregnancy Location for Pregnant Patients with
Abdominal Pain: Percentage of pregnant female patients aged 14 to 50 who
present to the emergency department (ED) with a chief complaint of abdominal pain
or vaginal bleeding who receive a trans-abdominal or trans-vaginal ultrasound to
determine pregnancy location
Rh Immunoglobulin (Rhogam) for Rh-Negative Pregnant Women at Risk of
Fetal Blood Exposure: Percentage of Rh-negative pregnant women aged 14-50
years at risk of fetal blood exposure who receive Rh-Immunoglobulin (Rhogam) in
the emergency department (ED)
Surveillance after Endovascular Abdominal Aortic Aneurysm Repair (EVAR):
Percentage of patients 18 years of age or older undergoing endovascular
abdominal aortic aneurysm repair (EVAR) who have at least one follow-up imaging
study after 3 months and within 15 months of EVAR placement that documents
aneurysm sac diameter and endoleak status
Statin Therapy at Discharge after Lower Extremity Bypass (LEB): Percentage
of patients aged 18 years and older undergoing infra-inguinal lower extremity
bypass who are prescribed a statin medication at discharge
Rate of Open Repair of Small or Moderate Non-Ruptured Abdominal Aortic
Aneurysms (AAA) without Major Complications (Discharged to Home by PostOperative Day #7): Percent of patients undergoing open repair of small or
moderate sized non-ruptured abdominal aortic aneurysms who do not experience a
major complication (discharge to home no later than post-operative day #7)
Rate of Endovascular Aneurysm Repair (EVAR) of Small or Moderate NonRuptured Abdominal Aortic Aneurysms (AAA) without Major Complications
(Discharged to Home by Post-Operative Day #2): Percent of patients undergoing
endovascular repair of small or moderate non-ruptured abdominal aortic aneurysms
(AAA) that do not experience a major complication (discharged to home no later
than post-operative day #2)
Measure
Developer
Reporting
Options
ACEP
Claims, Registry
ACEP
Claims, Registry
ACEP
Claims, Registry
SVS
Registry
SVS
Registry
SVS
Registry
SVS
Registry
Page 31 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
N/A
260
Care
Coordination
N/A
261.
Care
Coordination
N/A
262
Patient Safety
N/A
263
N/A
264
0645
265
Care
Coordination
266
Clinical
Process/
Effectiveness
N/A
Date: 11/16/2012
Version 7.1
Clinical
Process/
Effectiveness
Clinical
Process/
Effectiveness
Measure
Descriptiona
Rate of Carotid Endarterectomy (CEA) for Asymptomatic Patients, without
Major Complications (Discharged to Home by Post-Operative Day #2): Percent
of asymptomatic patients undergoing CEA who are discharged to home no later
than post-operative day #2
Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness:
Percentage of patients aged birth and older referred to a physician (preferably a
physician specially trained in disorders of the ear) for an otologic evaluation
subsequent to an audiologic evaluation after presenting with acute or chronic
dizziness
Image Confirmation of Successful Excision of Image–Localized Breast
Lesion: Image confirmation of lesion(s) targeted for image guided excisional biopsy
or image guided partial mastectomy in patients with nonpalpable, image-detected
breast lesion(s). Lesions may include: microcalcifications, mammographic or
sonographic mass or architectural distortion, focal suspicious abnormalities on
magnetic resonance imaging (MRI) or other breast imaging amenable to localization
such as positron emission tomography (PET) mammography, or a biopsy marker
demarcating site of confirmed pathology as established by previous core biopsy.
Preoperative Diagnosis of Breast Cancer: The percent of patients undergoing
breast cancer operations who obtained the diagnosis of breast cancer
preoperatively by a minimally invasive biopsy method
Sentinel Lymph Node Biopsy for Invasive Breast Cancer: The percentage of
clinically node negative (clinical stage T1N0M0 or T2N0M0) breast cancer patients
who undergo a sentinel lymph node (SLN) procedure
Biopsy Follow-Up: Percentage of new patients whose biopsy results have been
reviewed and communicated to the primary care/referring physician and patient by
the performing physician
Epilepsy: Seizure Type(s) and Current Seizure Frequency(ies): Percentage of
patient visits with a diagnosis of epilepsy who had the type(s) of seizure(s) and
current seizure frequency(ies) for each seizure type documented in the medical
record
Measure
Developer
Reporting
Options
SVS
Registry
AQC
Claims, Registry
ASBS
Claims, Registry
ASBS
Claims, Registry
ASBS
Registry
AAD
Registry
AAN
Claims, Registry
Page 32 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
267
Clinical
Process/
Effectiveness
N/A
268
Clinical
Process/
Effectiveness
N/A
269
Clinical
Process/
Effectiveness
N/A
270
Clinical
Process/
Effectiveness
N/A
271
Clinical
Process/
Effectiveness
N/A
272
Clinical
Process/
Effectiveness
N/A
273
Clinical
Process/
Effectiveness
N/A
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Epilepsy: Documentation of Etiology of Epilepsy or Epilepsy Syndrome: All
visits for patients with a diagnosis of epilepsy who had their etiology of epilepsy or
with epilepsy syndrome(s) reviewed and documented if known, or documented as
unknown or cryptogenic
Epilepsy: Counseling for Women of Childbearing Potential with Epilepsy: All
female patients of childbearing potential (12-44 years old) diagnosed with epilepsy
who were counseled about epilepsy and how its treatment may affect contraception
and pregnancy at least once a year
Inflammatory Bowel Disease (IBD): Type, Anatomic Location and Activity All
Documented: Percentage of patients aged 18 years and older with a diagnosis of
inflammatory bowel disease who have documented the disease type, anatomic
location and activity, at least once during the reporting period
Inflammatory Bowel Disease (IBD): Preventive Care: Corticosteroid Sparing
Therapy: Percentage of patients aged 18 years and older with a diagnosis of
inflammatory bowel disease who have been managed by corticosteroids greater
than or equal to 10 mg/day for 60 or greater consecutive days that have been
prescribed corticosteroid sparing therapy in the last reporting year
Inflammatory Bowel Disease (IBD): Preventive Care: Corticosteroid Related
Iatrogenic Injury – Bone Loss Assessment: Percentage of patients aged 18
years and older with a diagnosis of inflammatory bowel disease who have received
dose of corticosteroids greater than or equal to 10 mg/day for 60 or greater
consecutive days and were assessed for risk of bone loss once per the reporting
year
Inflammatory Bowel Disease (IBD): Preventive Care: Influenza Immunization:
Percentage of patients aged 18 years and older with a diagnosis of inflammatory
bowel disease for whom influenza immunization was recommended, administered
or previously received during the reporting year
Inflammatory Bowel Disease (IBD): Preventive Care: Pneumococcal
Immunization: Percentage of patients aged 18 years and older with a diagnosis of
inflammatory bowel disease that had pneumococcal vaccination administered or
previously received
Measure
Developer
Reporting
Options
AAN
Claims, Registry
AAN
Claims, Registry
AGA
IBD Measures Group
(R)
AGA
IBD Measures Group
(R)
AGA
IBD Measures Group
(R)
AGA
IBD Measures Group
(R)
AGA
IBD Measures Group
(R)
Page 33 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
N/A
274
Clinical
Process/
Effectiveness
N/A
275
Clinical
Process/
Effectiveness
N/A
276
Clinical
Process/
Effectiveness
N/A
277
Clinical
Process/
Effectiveness
N/A
278
Clinical
Process/
Effectiveness
N/A
279
Clinical
Process/
Effectiveness
N/A
280
Care
Coordination
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Inflammatory Bowel Disease (IBD): Testing for Latent Tuberculosis (TB)
Before Initiating Anti-TNF (Tumor Necrosis Factor) Therapy: Percentage of
patients aged 18 years and older with a diagnosis of inflammatory bowel disease for
whom a tuberculosis (TB) screening was performed and results interpreted within 6
months prior to receiving a first course of anti-TNF (tumor necrosis factor) therapy
Inflammatory Bowel Disease (IBD): Assessment of Hepatitis B Virus (HBV)
Status Before Initiating Anti-TNF (Tumor Necrosis Factor) Therapy:
Percentage of patients aged 18 years and older with a diagnosis of inflammatory
bowel disease who had Hepatitis B Virus (HBV) status assessed and results
interpreted within one year prior to receiving a first course of anti-TNF (tumor
necrosis factor) therapy
Sleep Apnea: Assessment of Sleep Symptoms: Percentage of visits for patients
aged 18 years and older with a diagnosis of obstructive sleep apnea that includes
documentation of an assessment of symptoms, including presence or absence of
snoring and daytime sleepiness
Sleep Apnea: Severity Assessment at Initial Diagnosis: Percentage of patients
aged 18 years and older with a diagnosis of obstructive sleep apnea who had an
apnea hypopnea index (AHI) or a respiratory disturbance index (RDI) measured at
the time of initial diagnosis
Sleep Apnea: Positive Airway Pressure Therapy Prescribed: Percentage of
patients aged 18 years and older with a diagnosis of moderate or severe obstructive
sleep apnea who were prescribed positive airway pressure therapy
Sleep Apnea: Assessment of Adherence to Positive Airway Pressure Therapy:
Percentage of visits for patients aged 18 years and older with a diagnosis of
obstructive sleep apnea who were prescribed positive airway pressure therapy who
had documentation that adherence to positive airway pressure therapy was
objectively measured
Dementia: Staging of Dementia: Percentage of patients, regardless of age, with a
diagnosis of dementia whose severity of dementia was classified as mild, moderate
or severe at least once within a 12 month period
Measure
Developer
Reporting
Options
AGA
IBD Measures Group
(R)
AGA
IBD Measures Group
(R)
AMAPCPI/NCQA
Sleep Apnea
Measures Group (R)
AMAPCPI/NCQA
Sleep Apnea
Measures Group (R)
AMAPCPI/NCQA
Sleep Apnea
Measures Group (R)
AMAPCPI/NCQA
Sleep Apnea
Measures Group (R)
AMAPCPI
Dementia Measures
Group (C/R)
Page 34 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
Clinical
Process/
Effectiveness
Clinical
Process/
Effectiveness
N/A
281
N/A
282
N/A
283
Clinical
Process/
Effectiveness
N/A
284
Clinical
Process/
Effectiveness
N/A
285
Clinical
Process/
Effectiveness
N/A
286
Patient Safety
N/A
287
Clinical
Process/
Effectiveness
288
Clinical
Process/
Effectiveness
N/A
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Dementia: Cognitive Assessment: Percentage of patients, regardless of age, with
a diagnosis of dementia for whom an assessment of cognition is performed and the
results reviewed at least once within a 12 month period
Dementia: Functional Status Assessment: Percentage of patients, regardless of
age, with a diagnosis of dementia for whom an assessment of patient’s functional
status is performed and the results reviewed at least once within a 12 month period
Dementia: Neuropsychiatric Symptom Assessment: Percentage of patients,
regardless of age, with a diagnosis of dementia and for whom an assessment of
patient’s neuropsychiatric symptoms is performed and results reviewed at least
once in a 12 month period
Dementia: Management of Neuropsychiatric Symptoms: Percentage of patients,
regardless of age, with a diagnosis of dementia who have one or more
neuropsychiatric symptoms who received or were recommended to receive an
intervention for neuropsychiatric symptoms within a 12 month period
Dementia: Screening for Depressive Symptoms: Percentage of patients,
regardless of age, with a diagnosis of dementia who were screened for depressive
symptoms within a 12 month period
Dementia: Counseling Regarding Safety Concerns: Percentage of patients,
regardless of age, with a diagnosis of dementia or their caregiver(s) who were
counseled or referred for counseling regarding safety concerns within a 12 month
period
Dementia: Counseling Regarding Risks of Driving: Percentage of patients,
regardless of age, with a diagnosis of dementia or their caregiver(s) who were
counseled regarding the risks of driving and the alternatives to driving at least once
within a 12 month period
Dementia: Caregiver Education and Support: Percentage of patients, regardless
of age, with a diagnosis of dementia whose caregiver(s) were provided with
education on dementia disease management and health behavior changes AND
referred to additional sources for support within a 12 month period
Measure
Developer
Reporting
Options
AMAPCPI
Dementia Measures
Group (C/R)
AMAPCPI
Dementia Measures
Group (C/R)
AMAPCPI
Dementia Measures
Group (C/R)
AMAPCPI
Dementia Measures
Group (C/R)
AMAPCPI
Dementia Measures
Group (C/R)
AMAPCPI
Dementia Measures
Group (C/R)
AMAPCPI
Dementia Measures
Group (C/R)
AMAPCPI
Dementia Measures
Group (C/R)
Page 35 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
N/A
289
Clinical
Process/
Effectiveness
N/A
290
Clinical
Process/
Effectiveness
N/A
291
N/A
292
N/A
293
Clinical
Process/
Effectiveness
N/A
294
Clinical
Process/
Effectiveness
295
Clinical
Process/
Effectiveness
N/A
Date: 11/16/2012
Version 7.1
Clinical
Process/
Effectiveness
Clinical
Process/
Effectiveness
Measure
Descriptiona
Parkinson’s Disease: Annual Parkinson’s Disease Diagnosis Review: All
patients with a diagnosis of Parkinson’s disease who had an annual assessment
including a review of current medications (e.g., medications that can produce
Parkinson-like signs or symptoms) and a review for the presence of atypical
features (e.g., falls at presentation and early in the disease course, poor response
to levodopa, symmetry at onset, rapid progression [to Hoehn and Yahr stage 3 in 3
years], lack of tremor or dysautonomia) at least annually
Parkinson’s Disease: Psychiatric Disorders or Disturbances Assessment: All
patients with a diagnosis of Parkinson’s disease who were assessed for psychiatric
disorders or disturbances (e.g., psychosis, depression, anxiety disorder, apathy, or
impulse control disorder) at least annually
Parkinson’s Disease: Cognitive Impairment or Dysfunction Assessment: All
patients with a diagnosis of Parkinson’s disease who were assessed for cognitive
impairment or dysfunction at least annually
Parkinson’s Disease: Querying about Sleep Disturbances: All patients with a
diagnosis of Parkinson’s disease (or caregivers, as appropriate) who were queried
about sleep disturbances at least annually.
Parkinson’s Disease: Rehabilitative Therapy Options: All patients with a
diagnosis of Parkinson’s disease (or caregiver(s), as appropriate) who had
rehabilitative therapy options (e.g., physical, occupational, or speech therapy)
discussed at least annually
Parkinson’s Disease: Parkinson’s Disease Medical and Surgical Treatment
Options Reviewed: All patients with a diagnosis of Parkinson’s disease (or
caregiver(s), as appropriate who had the Parkinson’s disease treatment options
(e.g., non-pharmacological treatment, pharmacological treatment, or surgical
treatment) reviewed at least once annually
Hypertension: Appropriate Use of Aspirin or Other Antithrombotic Therapy:
Percentage of patients aged 30 through 90 years old with a diagnosis of
hypertension and are eligible for aspirin or other antithrombotic therapy who were
prescribed aspirin or other antithrombotic therapy
Measure
Developer
Reporting
Options
AAN
Parkinson’s Disease
Measures Group (R)
AAN
Parkinson’s Disease
Measures Group (R)
AAN
Parkinson’s Disease
Measures Group (R)
AAN
Parkinson’s Disease
Measures Group (R)
AAN
Parkinson’s Disease
Measures Group (R)
AAN
Parkinson’s Disease
Measures Group (R)
ABIM
Hypertension
Measures Group (R)
Page 36 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
Clinical
Process/
Effectiveness
Clinical
Process/
Effectiveness
Clinical
Process/
Effectiveness
Clinical
Process/
Effectiveness
Clinical
Process/
Effectiveness
Clinical
Process/
Effectiveness
N/A
296
N/A
297
N/A
298
N/A
299
N/A
300
N/A
301
N/A
302
Clinical
Process/
Effectiveness
N/A
303
Clinical
Process/
Effectiveness
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Hypertension: Complete Lipid Profile: Percentage of patients aged 18 through 90
years old with a diagnosis of hypertension who received a complete lipid profile
within 60 months
Hypertension: Urine Protein Test: Percentage of patients aged 18 through 90
years old with a diagnosis of hypertension who either have chronic kidney disease
diagnosis documented or had a urine protein test done within 36 months
Hypertension: Annual Serum Creatinine Test: Percentage of patients aged 18
through 90 years old with a diagnosis of hypertension who had a serum creatinine
test done within 12 months
Hypertension: Diabetes Mellitus Screening Test: Percentage of patients aged 18
through 90 years old with a diagnosis of hypertension who had a diabetes screening
test within 36 months
Hypertension: Blood Pressure Control: Percentage of patients aged 18 through
90 years old with a diagnosis of hypertension who had most recent blood pressure
level under control (at goal)
Hypertension: Low Density Lipoprotein (LDL-C) Control: Percentage of patients
aged 18 through 90 years old with a diagnosis of hypertension who had most recent
LDL cholesterol level under control (at goal)
Hypertension: Dietary and Physical Activity Modifications Appropriately
Prescribed: Percentage of patients aged 18 through 90 years old with a diagnosis
of hypertension who received dietary and physical activity counseling at least once
within 12 months
Cataracts: Improvement in Patient’s Visual Function within 90 Days Following
Cataract Surgery: Percentage of patients aged 18 years and older in sample who
had cataract surgery and had improvement in visual function achieved within 90
days following the cataract surgery, based on completing a pre-operative and postoperative visual function survey
Measure
Developer
Reporting
Options
ABIM
Hypertension
Measures Group (R)
ABIM
Hypertension
Measures Group (R)
ABIM
Hypertension
Measures Group (R)
ABIM
Hypertension
Measures Group (R)
ABIM
Hypertension
Measures Group (R)
ABIM
Hypertension
Measures Group (R)
ABIM
Hypertension
Measures Group (R)
AAO
Registry, Cataract
Measures Group (R)
Page 37 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
N/A
304
Patient and
Family
Engagement
Safety
0004
305
Clinical
Process/
Effectiveness
0012
306
Population/
Public Health
0014
307
Patient Safety
0027
308
Population/
Public Health
0032
309
Clinical
Process/
Effectiveness
0033
310
Population/
Public Health
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Cataracts: Patient Satisfaction within 90 Days Following Cataract Surgery:
Percentage of patients aged 18 years and older in sample who had cataract surgery
and were satisfied with their care within 90 days following the cataract surgery,
based on completion of the Consumer Assessment of Healthcare Providers and
Systems Surgical Care Survey
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment:
(a) Initiation, (b) Engagement: Percentage of adolescent and adult patients with a
new episode of alcohol or other drug (AOD) dependence who initiate treatment
through an inpatient AOD admission, outpatient visit, intensive outpatient encounter
or partial hospitalization within 14 days of the diagnosis and who initiated treatment
AND who had two or more additional services with an AOD diagnosis within 30
days of the initial visit
Prenatal Care: Screening for Human Immunodeficiency Virus (HIV):
Percentage of patients, regardless of age, who gave birth during a 12-month period
who were screened for HIV infection during the first or second prenatal visit
Prenatal Care: Anti-D Immune Globulin: Percentage of D (Rh) negative,
unsensitized patients, regardless of age, who gave birth during a 12-month period
who received anti-D immune globulin at 26-30 weeks gestation
Smoking and Tobacco Use Cessation, Medical Assistance: a. Advising
Smokers and Tobacco Users to Quit, b. Discussing Smoking and Tobacco
Use Cessation Medications, c. Discussing Smoking and Tobacco Use
Cessation Strategies: Percentage of patients aged 18 years and older who were
current smokers or tobacco users, who were seen by a practitioner during the
measurement year and who received advice to quit smoking or tobacco use or
whose practitioner recommended or discussed smoking or tobacco use cessation
medications, methods or strategies
Cervical Cancer Screening: Percentage of women aged 21 through 63 years who
received one or more Pap tests to screen for cervical cancer
Chlamydia Screening for Women: Percentage of women aged 15 through 24
years who were identified as sexually active and who had at least one test for
chlamydia during the measurement year
Measure
Developer
Reporting
Options
AAO
Registry, Cataract
Measures Group (R)
NCQA
EHR
AMAPCPI
EHR
AMAPCPI
EHR
NCQA
EHR
NCQA
EHR
NCQA
EHR
Page 38 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
Clinical
Process/
Effectiveness
Efficient Use
of Healthcare
Resources
Clinical
Process/
Effectiveness
0036
311
0052
312
0575
313
N/A
316
N/A
317
GPRO
PREV11
Population/
Public Health
0101
318
GPRO
CARE-2
Patient Safety
Date: 11/16/2012
Version 7.1
Clinical
Process/
Effectiveness
Measure
Descriptiona
Use of Appropriate Medications for Asthma: Percentage of patients aged 5
through 50 years of age who were identified as having persistent asthma and were
appropriately prescribed medication during the measurement year
Low Back Pain: Use of Imaging Studies: Percentage of patients with a primary
diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT
scan) within 28 days of diagnosis
Diabetes Mellitus: Hemoglobin A1c Control (< 8%): The percentage of patients
18 through 75 years of age with a diagnosis of diabetes (type 1 or type 2) who had
HbA1c < 8%
Preventive Care and Screening: Cholesterol – Fasting Low Density
Lipoprotein (LDL) Test Performed AND Risk-Stratified Fasting LDL:
Percentage of patients aged 20 through 79 years whose risk factors* have been
assessed and a fasting LDL test has been performed
*There are three criteria for this measure based on the patient’s risk category.
1. Highest Level of Risk: Coronary Heart Disease (CHD) or CHD Risk Equivalent
2. Moderate Level of Risk: Multiple (2+) Risk Factors
3. Lowest Level of Risk: 0 or 1 Risk Factor
Preventive Care and Screening: Screening for High Blood Pressure and
Follow-Up Documented: Percentage of patients aged 18 years and older seen
during the reporting period who were screened for high blood pressure (BP) AND a
recommended follow-up plan is documented based on the current blood pressure
reading as indicated
Falls: Screening for Future Fall Risk: Percentage of patients aged 65 years and
older who were screened for future fall risk at least once within the reporting period
Measure
Developer
Reporting
Options
NCQA
EHR
NCQA
EHR
NCQA
EHR
CMS/QIP
EHR
CMS/QIP
Claims, Registry,
EHR, GPRO/ACO,
Cardiovascular
Prevention Measures
Group (C/R)
AMAPCPI/NCQA
GPRO/ACO
Page 39 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
0729
319
GPRO
DM-13
thru
DM-17
Clinical
Process/
Effectiveness
0658
320
Care
Coordination
0493
321
Care
Coordination
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Diabetes Composite: Optimal Diabetes Care: Patients ages 18 through 75 with a
diagnosis of diabetes, who meet all the numerator targets of this composite
measure:
x A1c < 8.0%, LDL < 100 mg/dL,
x blood pressure < 140/90 mmHg,
x tobacco non-user and
for patients with a diagnosis of ischemic vascular disease daily aspirin use
unless contraindicated
Endoscopy/Polyp Surveillance: Appropriate Follow-Up Interval for Normal
Colonoscopy in Average Risk Patients: Percentage of patients aged 50 years
and older receiving a screening colonoscopy without biopsy or polypectomy who
had a recommended follow-up interval of at least 10 years for repeat colonoscopy
documented in their colonoscopy report
Participation by a Hospital, Physician or Other Clinician in a Systematic
Clinical Database Registry that Includes Consensus Endorsed Quality:
Participation in a systematic qualified clinical database registry involves:
a. Physician or other clinician submits standardized data elements to registry.
b. Data elements are applicable to consensus endorsed quality measures.
c. Registry measures shall include at least two (2) representative NQF consensus
endorsed measures for registry's clinical topic(s) and report on all patients eligible
for the selected measures.
d. Registry provides calculated measures results, benchmarking, and quality
improvement information to individual physicians and clinicians.
e. Registry must receive data from more than 5 separate practices and may not be
located (warehoused) at an individual group’s practice. Participation in a national or
state-wide registry is encouraged for this measure.
f. Registry may provide feedback directly to the provider’s local registry if one exists.
Measure
Developer
Reporting
Options
MNCM
GPRO/ACO
AMA-PCPI
Claims, Registry
OFMQ
Claims, Registry
Page 40 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
0670
322
Efficient Use
of Healthcare
Resources
0671
323
Efficient Use
of Healthcare
Resources
0672
324
Efficient Use
of Healthcare
Resources
N/A
325
Clinical
Process/
Effectiveness
Date: 11/16/2012
Version 7.1
Measure
Descriptiona
Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Preoperative
Evaluation in Low Risk Surgery Patients: Percentage of stress single-photon
emission computed tomography (SPECT) myocardial perfusion imaging (MPI),
stress echocardiogram (ECHO), cardiac computed tomography angiography
(CCTA), or cardiac magnetic resonance (CMR) performed in low risk surgery
patients 18 years or older for preoperative evaluation during the 12-month reporting
period
Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Routine Testing
After Percutaneous Coronary Intervention (PCI): Percentage of all stress singlephoton emission computed tomography (SPECT) myocardial perfusion imaging
(MPI), stress echocardiogram (ECHO), cardiac computed tomography
angiography (CCTA), and cardiovascular magnetic resonance (CMR) performed in
patients aged 18 years and older routinely after percutaneous coronary intervention
(PCI), with reference to timing of test after PCI and symptom status
Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Testing in
Asymptomatic, Low-Risk Patients: Percentage of all stress single-photon
emission computed tomography (SPECT) myocardial perfusion imaging (MPI),
stress echocardiogram (ECHO), cardiac computed tomography angiography
(CCTA), and cardiovascular magnetic resonance (CMR) performed in
asymptomatic, low coronary heart disease (CHD) risk patients 18 years and older
for initial detection and risk assessment
Adult Major Depressive Disorder (MDD): Coordination of Care of Patients with
Specific Comorbid Conditions: Percentage of medical records of patients aged
18 years and older with a diagnosis of major depressive disorder (MDD) and a
diagnosed comorbid condition (diabetes, coronary artery disease, ischemic stroke,
intracranial hemorrhage, chronic kidney disease [stages 4 or 5], ESRD or
congestive heart failure) being treated by another clinician with communication to
the other clinician treating the comorbid condition
Measure
Developer
Reporting
Options
ACC
Registry
ACC
Registry
ACC
Registry
AMAPCPI
Registry
Page 41 of 44
2013 PQRS Measures List
NQF
#
PQRS
#
National
Quality
Strategy
Domain
1525
326
Patient Safety
N/A
327
Clinical
Process/
Effectiveness
1667
328
Clinical
Process/
Effectiveness
a)
b)
c)
Measure
Descriptiona
Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy: Patients
aged 18 and older with a diagnosis of nonvalvular AF or atrial flutter whose
assessment of specified thromboembolic risk factors indicate one or more high-risk
factors or more than one moderate risk factor, as determined by CHADS2 risk
stratification, who were prescribed warfarin OR another oral anticoagulant drug that
is FDA approved for the prevention of thromboembolism
Pediatric Kidney Disease: Adequacy of Volume Management: Percentage of
calendar months within a 12-month period during which patients aged 17 years and
younger with a diagnosis of End Stage Renal Disease (ESRD) undergoing
maintenance hemodialysis in an outpatient dialysis facility have an assessment of
the adequacy of volume management from a nephrologist
Pediatric Kidney Disease: ESRD Patients Receiving Dialysis: Hemoglobin
Level < 10g/dL: Percentage of calendar months within a 12-month period during
which patients aged 17 years and younger with a diagnosis of End Stage Renal
Disease (ESRD) receiving hemodialysis or peritoneal dialysis have a hemoglobin
level < 10 g/dL
Measure
Developer
AMAPCPI/ACCF/A
HA
Reporting
Options
Claims, Registry
AMAPCPI
Claims, Registry
AMAPCPI
Claims, Registry
Measure titles and descriptions for some measures may vary by measure reporting options/methods for a particular program year. This is due to the timing of measure
specification preparation for the various reporting options/methods. The titles and descriptions referenced in this document refer to the claims/registry measure
specifications. Please refer to the measure specifications that apply to the other reporting options/methods for the measure details (e.g., measure titles and descriptions)
that apply to those specific options/methods.
A list of Registries and qualified EHR vendors and products for the 2013 program year will be available on the Alternative Reporting Mechanisms section available from
the navigation bar on the left side of the CMS PQRS website. Please visit this site periodically for updates and contact your EHR vendor or registry to determine if they
are planning to become qualified for upcoming program years.
1. PQRS Registry website: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Registry-Reporting.html
2. PQRS EHR: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Electronic-Health-Record-Reporting.html
The Group Practice Reporting Option (GPRO) is only available to those group practices participating in the PQRS group practice reporting option (GPRO) reporting via
the Web Interface. For information on how to self-nominate/register to participate in the GPRO, refer to the downloads on the Group Practice Reporting Option section
available from the navigation bar on the left side of the CMS PQRS website. Please visit this site periodically for updates.
1. PQRS GPRO website: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Group_Practice_Reporting_Option.html
Date: 11/16/2012
Version 7.1
Page 42 of 44
2013 PQRS Measures List
Appendix I - Measure Specifications
Reporting
Measure Specification Name
Option/Method
Claims
2013 PQRS Measure Specifications Manual for
Claims and Registry Reporting of Individual Measures
and Release Notes
CMS PQRS website location
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/MeasuresCodes.html
2013 PQRS Measure Specifications Manual for Claims and Registry Reporting of
Individual Measures and Release Notes ZIP file
Registry
2013 PQRS Measure Specifications Manual for
Claims and Registry Reporting of Individual Measures
and Release Notes
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/MeasuresCodes.html
2013 PQRS Measure Specifications Manual for Claims and Registry Reporting of
Individual Measures and Release Notes ZIP file
EHR
Electronic Health
Record
2013 EHR Measure Specifications and Release Notes
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/Electronic-Health-Record-Reporting.html
EHR Documents for Eligible Professionals ZIP file
Measures
Groups
2013 PQRS Measures Groups Specifications Manual
and Release Notes
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/MeasuresCodes.html
2013 PQRS Measures Groups Specifications Manual and Release Notes ZIP file
GPRO
Group Practice
Reporting Option
NOTE: Refer to these measure specifications for more
information on which reporting mechanism (claims or
registry) may be used to submit each Measures
Group.
2013 PQRS GPRO Narrative Measure Specifications http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessmentand Release Notes
Instruments/PQRS/Group_Practice_Reporting_Option.html
2013 PQRS GPRO Narrative Measure Specifications and Release Notes ZIP file
Date: 11/16/2012
Version 7.1
Page 43 of 44
2013 PQRS Measures List
Appendix II - Measure Developer/Contact Information
Acronym
Full Name
AAD
American Academy of Dermatology
AAN
American Academy of Neurology
AAO
American Academy of Ophthalmology
ABIM
American Board of Internal Medicine
ACC
American College of Cardiology
ACEP
American College of Emergency Physicians
AGA
American Gastroenterological Association
AHA
American Heart Association
AMA-PCPI
American Medical Association (AMA)-convened Physician
Consortium for Performance Improvement® (PCPI™)
APMA
American Podiatric Medical Association
ASBS
American Society of Breast Surgeons
ASH
American Society of Hematology
ASCO
American Society of Clinical Oncology
ASHA
American Speech-Language-Hearing Association
ASA
American Stroke Association
AQC
Audiology Quality Consortium
CAP
College of American Pathologists
CMS
Centers for Medicare & Medicaid Services
MNCM
Minnesota Community Measurement
OFMQ
Oklahoma Foundation for Medical Quality
QIP
Quality Insights of Pennsylvania
FOTO
Focus on Therapeutic Outcomes
NCCN
National Comprehensive Cancer Network
NCQA
National Committee for Quality Assurance
STS
The Society of Thoracic Surgeons
SVS
Society for Vascular Surgery
Date: 11/16/2012
Version 7.1
Contact
e-mail questions and comments to [email protected]
e-mail questions and comments to [email protected]
e-mail questions and comments to [email protected] or [email protected]
e-mail questions and comments to [email protected]
e-mail questions and comments to [email protected]
e-mail questions and comments to [email protected]
e-mail questions and comments to [email protected]
e-mail questions and comments to [email protected]
e-mail questions and comments to the PCPI at [email protected]
e-mail questions and comments to [email protected]
e-mail questions and comments to [email protected]
e-mail questions and comments to [email protected]
http://www.asco.org and click on “Contact Us”
e-mail questions and comments to [email protected]
http://www.heart.org/HEARTORG/General/Contact-Us_UCM_308813_Article.jsp
e-mail questions and comments to [email protected] or [email protected]
e-mail questions and comments to http://www.cap.org
e-mail questions and comments to [email protected]
e-mail questions and comments to [email protected]
email questions and comments to https://cms-ip.custhelp.com/
http://www.usqualitymeasures.org/For-Your-Information/contact.aspx
e-mail questions and comments to [email protected]
http://www.nccn.org/about/contact.asp
http://www.ncqa.org and click on “Contact Us”
e-mail questions and comments to [email protected]
e-mail questions and comments at http://www.vascularweb.org
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| File Type | application/pdf |
| File Title | 2013 Physician Quality Reporting System Measures List |
| Subject | 2013 Physician Quality Reporting System Measures List |
| Author | PMBR/CMS |
| File Modified | 2013-09-16 |
| File Created | 2013-09-16 |