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2016 PQRS Measures for Physical Therapy

January 1, 2016 1 Comment

Time to get started to with 2016 PQRS measures for physical therapy!  wordleAs the new year begins physical therapists may find themselves in one of three situations regarding PQRS reporting:  1) Successful reporting in 2014, and therefore no reductions to Medicare payments in 2016. 2) Notification that 2014 reporting was unsuccessful and therefore a 2% payment penalty applies to Medicare reimbursements this year. 3) Never having reported, which could mean a 2% reduction in 2016 or alternatively you are a new provider and eligible to report in 2016.  This article will give you a brief overview, and if you are looking for more information be sure to sign up for this complimentary webinar: 2016 Medicare Changes: What Every Therapist Needs to Know.

2016 PQRS Measures Reporting Options

PQRS reporting is for physical therapists in private practice.  Therapists in hospital departments, skilled facilities, rehab agencies, home health agencies and CORFs are not eligible provider (EP) for the purpose of PQRS.  Therapists in private practice have the option of reporting via a registry or via claims.  Those reporting via registry may also select the group practice reporting option (GPRO).  If you are reporting via a registry there are also additional required measures.  CMS provides a listing of qualified registries (2015) including FOTO.  The easiest way for physical therapists in private practice to get started is via claims based reporting. The table below lists the individual measures that are required for PT claims based reporting.  Note that although CMS requires that reporting be completed on nine (9) measures, there are only 6 applicable measures, therefore all must be completed.  Be sure to read through the CMS PQRS measure specifications so that your documentation and coding are compliant.  Once you have your sea legs on PQRS be sure to try out the CMS online interactive tool.

2016 PQRS Measures for Physical Therapists

Measure #Measure Description
128Preventive Care and Screening: BMI Screening and Follow-up
130Documentation and Verification of Current Medications in the Medical Record
131Pain Assessment Prior to Initiation of Patient Treatment
154Falls: Risk Assessment
155Falls: Plan of Care
182Functional Outcome Assessment
Table Note: Select all six 2016 codes for PT claims based reporting. Be sure to read 2016 measure specifications for each code to ensure compliance in reporting.


Are you ready for successful PQRS reporting in 2016?  Do you have a 2% payment reduction this year and hope to avoid a PQRS 2% payment penalty for 2017 by successfully reporting this year?  Do you need more information on successful PQRS reporting?

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Nancy Beckley

Nancy J. Beckley MS, MBA, CHC: President-Nancy Beckley & Associates LLC. Compliance outsourcing, risk assessment, compliance plans, compliance training, auditing, due diligence, investigation support for therapy providers.

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