Quality Reporting for MACRA (Reporting only Codes)

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Quality Reporting for MACRA (Reporting only Codes)


Date Issued: 06/01/2020


What is MACRA?

MACRA combines parts of the Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VBM), and the Medicare Electronic Health Record (EHR) incentive program into one single program called the Merit-based Incentive Payment System, or “MIPS”.

Reporting quality measures for Medicare MIPS (former PQRS program) is often integrated into EMR systems.  In smaller practices claim based reporting may still be allowed.

Reporting only codes for MIPS are considered Status M codes as Measurement only codes.  The former PQRS measurement codes are considered Status I (not valid for Medicare purposes) and should no longer be used.

EmblemHealth will accept both Status M and Status I quality measure HCPCS codes for reporting purposes only; these codes will be paid at $0.00.  The claims adjustment code will be CO-246 and remark code N620, consistent with CMS.

The charge amount should be $0.00 charge.  If your billing software does not allow a $0.00 charge, you can use a small amount such as $0.01, which you will have to adjust. The quality code must be submitted on the same claim form as your charges for services.