2014 PQRS Final Update

Author:Kim Cavitt, Au.D.

We hope that each audiologist in every practice reported at least one PQRS measure on at least one patient in 2013. This was your means of avoiding the 2015 1.5% Medicare reimbursement penalty. Measure #188 (Referral for Otologic Evaluation for Patients with Congenital or Traumatic Deformity of the Ear) was eliminated for 2014. As a result, audiologists have three measures they may report in 2014:
  • Measure #261: Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness
  • Measure #130: Documentation of Current Medications in the Medical Record
  • Measure #134: Screening for Clinical Depression and Follow-Up Plan
The details of 2014 PQRS implementation for audiology have been finalized. To avoid the 2014 2.0% Medicare penalty AND qualify for the 2014 0.5% incentive, audiologists must report the following:
  • Report on Measure #261 (Dizziness) on at least 50% of each provider’s Medicare claims which contain the diagnosis codes of 780.4 (Dizziness) or 386.11 (BPPV).
  • Report on Measure #130 (Documentation of current medications) on at least 50% of each provider’s Medicare claims where they bill for a hearing test, caloric testing, tympanometry, auditory brainstem response testing, comprehensive otoacoustic emissions, and/or cochlear implant/auditory osseointegrated device candidacy testing.
Measure 2014 Benchmark
#261: Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness One time per calendar year for 50% of the eligible Medicare patient
#130: Documentation of Current Medications in the Medical Record 50% of every eligible Medicare patient visit


Measure #134 is an optional measure; as a result, you will not be penalized for failure to report on this measure and the lack of reporting this measure will not affect you ability to qualify for the incentive. It should be noted though that, when appropriately reporting Measure #134, your incentive payment could be increased (if no other measure is reported on this claim) due to the addition of another measure.

  • We advise that each provider report on Measure #134 (Screening for clinical depression with follow-up plan) on every Medicare claim where you bill for a hearing test, tympanometry, tinnitus assessment and/or cochlear implant/auditory osseointegrated device candidacy testing AND when:
    • Allowed by their state licensure law (when deemed within the scope of practice of an audiologist within your state; determined through written contact with their state licensing board)
    • The provider is appropriately trained and competent to screen with a standardized tool AND create a patient plan of care
    • A follow-up plan of care is created, implemented and documented in the medical record
Details of 2014 PQRS measures
Measure: #261: Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness
Reporting Criteria: Patients of any age with the following procedure codes and associated diagnosis codes should be reported once per year per patient.
CPT Codes ICD-9 Codes G-modifiers
92540, 92541, 92542, 92543, 92544, 92545, 92546, 92547, 92548, 92550, 92557, 92567, 92568, 92570, 92575 780.4, 386.11 G8856: Referral to a physician for otologic evaluation performed
G8857: Patient is not eligible for the referral for otologic evaluation measure (e.g., patients who are already under the care of a physician for acute or chronic dizziness)
G8858: Referral to a physician for an otologic evaluation not performed, reason not specified


Measure: #130: Documentation of Current Medications in the Medical Record Reporting Criteria: Patients ≥ 18 years with the following procedure codes should be reported for every patient visit.
CPT Codes ICD-9 Codes G-modifiers
92541, 92542, 92543, 92544, 92545, 92547, 92548, 92557, 92567, 92568, 92570, 92585, 92588, 92626 No specific ICD-9 codes are included for this measure G8427: List of current medications (includes prescription, over-the-counter, herbals, vitamin/mineral/dietary [nutritional] supplements) documented by the provider, including drug name, dosage, frequency, and route
G8430: Provider documentation that patient is not eligible for medication assessment
G8428: Current medications (includes prescription, over-the-counter, herbals, vitamin/mineral/dietary [nutritional] supplements) with drug name, dosage, frequency, and route not documented by the provider, reason not specified


Measure: #134: Preventative Care and Screening: Screening for Clinical Depression and Follow-Up Plan Reporting Criteria: Patients ≥ 12 years with the following procedure codes should be reported once per year per patient.
CPT Codes ICD-9 Codes G-modifiers
92557, 92567, 92568, 92625, 92626 No specific ICD-9 codes are included for this measure G8431: Positive screen for clinical depression using an age appropriate standardized tool and a follow-up plan documented
G8510: Negative screen for clinical depression using an age appropriate standardized tool, follow-up not required
G8433: Screening for clinical depression using an age appropriate standardized tool not documented, patient not eligible/appropriate
G8432: No documentation of clinical depression screening using an age appropriate standardized tool
G8511: Positive screen for clinical depression using an age appropriate standardized tool documented, follow-up plan not documented, reason not specified


For more information, please contact Kim Cavitt, Au.D. at kim.cavitt@audiologyresources.com or 773-960-6625.    
Kim Cavitt, Au.D. was a clinical audiologist and preceptor at The Ohio State University and Northwestern University for the first ten years of her career. Since 2001, Dr. Cavitt has operated her own Audiology consulting firm, Audiology Resources, Inc. She currently serves on the Board of the Academy of Doctors of Audiology and the State of Illinois Speech Pathology and Audiology Licensure Board. She also serves on committees through AAA and ASHA and is an Adjunct Lecturer at Northwestern University.