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  • Savvy Coder

    What’s New With the PQRS and E-Prescribing Programs

    By Sue Vicchrilli, COT, OCS, Academy Coding Executive, and Kelsey Kurth, MPP, Manager, Quality & Payment Policy

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    Is your practice participating in the e-prescribing and Physician Quality Reporting System (PQRS) programs? If not, find out how to get started at Here’s a quick summary of the programs’ financial impact plus highlights of what’s new this year. 

    PQRS—financial impact. With 15 ophthalmic measures or the option to report the cataract measure group (see "Ophthalmic Measures in PQRS"), ophthalmologists of all subspecialties may report for the incentive payment and avoid future penalties. If you participate successfully in 2013, you will receive a 0.5 percent payment incentive on all your allowable amounts (less durable medical equipment and any injectable drug) for Medicare Part B, Medicare as a secondary payer, and Railroad Medicare payments. However, if you don’t participate, you will receive a 1.5 percent decrease in those payments. (If you participate unsuccessfully, you don’t get the payment incentive, but you may still avoid the 1.5 percent decrease.)

    PQRS—what’s new for 2013. Measures 12 and 141 no longer include glaucoma staging codes 365.70, 365.71, 365.72, 365.73, and 365.74. Measure 124 (health information technology) is eliminated. And the cataract group measure now requires 20 surgical patients instead of 30. A majority of those 20 patients must be Medicare Part B patients. You won’t be able to report on this group until April. Also, the patient surveys for measures 303 and 304 will be offered online with a mail-in option.

    E-Rx—financial impact. If none of the exemption categories apply, you will suffer a 2 percent payment adjustment in 2014 unless you report G8553 a minimum of 10 times between Jan. 1 and June 30 of this year. This must be reported via claims. In order to qualify for the 0.5 percent incentive payment, at least 25 e-prescriptions associated with an exam must be submitted between Jan. 1 and Dec. 31 of this year.

    E-Rx—automatic exemptions. This year, two new automatic exemptions have been added that allow you to avoid the 2014 penalty: 1) You achieved EHR meaningful use sometime between Jan. 1, 2012, and June 30, 2013, or 2) you registered for the EHR incentive program and adopted EHR between Jan. 2, 2013, and Jan. 31, 2014.

    E-Rx—hardship exemptions. You can apply for a hardship exemption by June 30, 2013, if you meet the following criteria: 1) You prescribed or expect to prescribe fewer than 100 prescriptions in the Jan. 1 through June 30, 2013, reporting period, 2) you are unable to electronically prescribe due to local, state, or federal law or regulation (i.e., those physicians who prescribe a high volume of narcotics), 3) you practice in a rural area without sufficient high-speed Internet access, or 4) you practice in an area without sufficient available pharmacies for electronic prescribing. 

    Ophthalmic Measures in PQRS

    Measures that may be reported via claims or registry: 12, 14, 18, 19, 117, 130, 140, 141, and 226.

    Measures that can only be reported through a qualified registry: 137, 138, 191, 192, 224, and 265. (The Academy has partnered with Outcome Registry, which is online at

    Measures by specialty: Cornea (130 and 226), glaucoma (12, 130, 141, and 226), neuro-ophthalmology (130 and 226), oculoplastics (130, 137, 138, and 226), pediatric ophthalmology (130 and 226), and retina (14, 18, 19, 117, 130, 140, and 226). 

    Cataract measures group: 191, 192, 303, and 304. 

    More online: For full information on these 15 measures, visit advocacy/reimbursement/ and select “PQRS,” then “List of ophthalmic measures.”