MIPS 2021 Logic Document

For 2021, we have outlined the changes to the MIPS measure in In Touch EMR as provided by CMS. This will allow you to be compliant with all MIPS changes, once you follow the prompts.

 

Please click here for the CMS document outlining all the changes.

 

MIPS MEASURE #128 - Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

Denominator:

1. Patients aged 18 years or older

2. Performed at least one eligible CPT or HCPCS: 

90791, 90792, 90832, 90834, 90837, 96156, 96158, 97161, 97162, 97163, 97165, 97166, 97167, 97802, 97803, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99236, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99339, 99340, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, D7111, D7140, D7210, D7220, D7230, D7240,D7241, D7250, D7251,G0101, G0108, G0270, G0271, G0402, G0438, G0439, G0447, G0473

3. Without Telehealth modifier(GQ,GT,95, POS 02)

2021 update:

Removed CPT code 99201

Added new Denominator Exception: G2181: BMI not documented due to medical reason OR patient refusal of height or weight measurement.

 

MIPS MEASURE #130 - Documentation of Current Medications in the Medical Record

Denominator:

1. Patients aged 18 years or older

2. Performed atleast one eligible CPT or HCPCS: 

59400, 59510, 59610, 59618, 90791, 90792, 90832, 90834, 90837, 90839, 92002, 92004, 92012, 92014, 92507, 92508, 92526, 92537, 92538, 92540, 92541, 92542, 92544, 92545, 92548, 92550, 92557, 92567, 92568, 92570, 92588, 92626, 96116, , 96156, 96158, , 97129,97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97802, 97803, 97804, 98960, 98961, 98962, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99236, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99339, 99340, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99495, 99496, 99281, 99282, 99283, 99284, 99285, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, G0101, G0108, G0270, G0402, G0438, G0439

2021 update:

Removed CPT codes: 92521, 92522, 92523, 92585, 96105, 99201, G0515

Added CPT codes: 92507, 92508, 92526

Updated Denominator Exclusion: G8430: Current Medications not Documented, Updated, or Reviewed for Medical Reason(s). Patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient's health status.

 

MIPS MEASURE #134 - Preventive Care and Screening: Screening for Depression and Follow- Up Plan

Denominator:

1. Patients aged 12 years or older

2. Have at least one of the following diagnosis: 

Z1331, Z1332

3. Performed at least one eligible CPT or HCPCS: 

59400, 59510, 59610, 59618, 90791, 90792, 90832, 90834, 90837, 92625, 96105, 96110, 96112, 96116, 96125, 96136, 96138, 96156, 96158, 97161, 97162, 97163, 97165, 97166, 97167, 99078, 99202, 99203, 99204, 99205, 99212,99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324,99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99339, 99340, 99401*, 99402*, 99403*, 99483, 99484, 99492, 99493,99384*, 99385*, 99386*, 99387*, 99394*, 99395*, 99396*, 99397*, G0101, G0402, G0438, G0439, G0444

4. Not eligible if have diagnosis: 

F01.51, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.89, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.1, F34.81, F34.89, F43.21, F43.23, F53.0, F53.1, O90.6, O99.340, O99.341, O99.342, O99.343, O99.345, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, F31.70, F31.71, F31.72, F31.73, F31.74, F31.75, F31.76, F31.77, F31.78, F31.81, F31.89, F31.9

2021 update:

Removed CPT code 99201

  Updated Denominator Exclusion: G9717: Documentation stating the patient has had a

diagnosis of depression or has had a diagnosis of bipolar disorder.

 

MIPS MEASURE #154 -  Falls: Risk Assessment

Denominator:

1. Patients aged 65 years or older

2. Must have history of Falls set to ‘Yes’ in subjective

3. Performed atleast one eligible CPT or HCPCS: 

92540, 92541, 92542, 92548, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439

2021 update:

Removed CPT codes: 99201

 

MIPS MEASURE #155 - Falls: Plan of Care

Denominator:

1. 3288F, Risk Assessment for Falls Documented AND 1100F, Patient screened for future fall risk; documentation of two or more falls in the past year or anyfall with injury in the past year

OR

3288F with 1P, Documentation of medical reason(s) for not completing a risk assessment for falls AND 1100F, Patient screened for future fall risk; documentation of two or more falls in the past year or anyfall with injury in the past year

OR

3288F with 8P, Falls risk assessment not completed, reason not otherwise specified AND 1100F, Patient screened for future fall risk; documentation of two or more falls in the past year or anyfall with injury in the past year

must have been reported from #154 Falls: Risk Assessment

 

MIPS MEASURE #181 -  Elder Maltreatment Screen and Follow-Up Plan

Denominator:

1.       Patients aged 65 years or older

2.       Have at least one of the following diagnosis: 

T7411XA, T7411XD, T7411XS, T7421XA, T7421XD, T7421XS, T7431XA, T7431XD, T7431XS, T7611XA, T7611XD, T7611XS, T7621XA, T7621XD, T7621XS, T7631XA, T7631XD, T7631XS, Z0471, Z6911, Z6912, Z6981, Z6982, T7401XA, T7401XD, T7401XS, Y0701, Y0702, Y0703, Y0704, Y07410, Y07411, Y0711, Y0712, Y0713, Y0714, Y07420, Y07421, Y07430, Y07432, Y07433, Y07434, Y07435, Y07436, Y07490, Y07491, Y07499, Y0750, Y07512, Y07513, Y07521, Y07528, Y07529, Y0753, Y0759, Y079, Z91412, T7601XA, T7601XD, T7601XS, Z91410, Z91411, Z62813, T7451XA, T7451XD, T7451XS, E9170, E9175, E9174, E9178, E9171, E9176, X0801XD, X0801XS, X0809XA, X0809XD, X0810XD, X023, X025, V9024, V9025, V9021, V9027, V9029

3. Performed at least one eligible CPT or HCPCS:

90791, 90792, 90832, 90834, 90837,92002, 92004, 92012, 92014, 92521, 92522, 92523, 92524, 92537, 92538, 92540, 92541, 92542, 92544, 92545, 92546, 92548, 92550, 92557, 92567, 92568, 92570, 92587,  92588, 92610, 92620, 92625, 92626, 96105, 96112, 96116, 96125, 96130, 96132, 96136, 96138, 96156, 96158, 97161, 97162, 97163, 97165, 97166, 97167, 97168, 97802, 97803, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99401*, 99402*, 99403*, 99404*, 99483, 99490, 99491, 99492, G0101, G0102, G0270, G0402, G0438, G043

4. Without Telehealth modifier(GQ,GT,95, POS 02)

2021 update:

Removed CPT codes: 92526, 92585, 99201

Added CPT Codes: 92524, 92546, 92587, 92610, 92620, 92625, 92626, 96112, 96125, 99490, 99491

 

MIPS MEASURE #182 - Functional Outcome Assessment

Denominator:

1. Patients aged 18 years or older

2. Performed at least one eligible CPT: 

92540, 92541, 92542, 92548, 92610, 92611, 92612, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 98940, 98941, 98942, 98943, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 92537, 92546, 92605, 92607, 92614, 92615, 92616, 92620, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350

2021 update:

Removed CPT codes: 99201

Added CPT Codes: 92537, 92546, 92605, 92607, 92614, 92615, 92616, 92620, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350

 

MIPS MEASURE #226 - Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Criteria 1 Denominator:

1. Patients aged 18 years or older

2. Performed at least one eligible CPT or HCPCS: 

90791, 90792, 90832, 90834, 90837, 90845, 92002, 92004, 92012, 92014, 92521, 92522, 92523, 92524, 92540, 92557, 92625, 96156, 96158, 97165, 97166, 97167, 97168, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, G0438, G0439, 97161, 97162, 97163

2021 update:

Removed CPT codes: 99201

Added CPT codes: 97161, 97162, 97163

In 2021, the following CPT codes should be allowed even if they have the telehealth modifiers GQ, GT, 95, POS 02.

 

Criteria 2 Denominator:

1. G9902 Must have been reported from Criteria 1

 

Criteria 3 Denominator:

1. G9906 Must have been reported from Criteria 2

 

Other Articles