Speech-language pathologists (SLPs) who see Medicare Part B (outpatient) beneficiaries and exceed the low-volume threshold for claims may be required to participate in the Merit-Based Incentive Payment System (MIPS). Use the 2022 MIPS Eligibility and Participation Quick Start Guide [PDF] to determine if you are required to participate.
The Centers for Medicare and Medicaid Services (CMS) requires MIPS-eligible providers to report at least six quality measures for eligible Medicare patient visits to earn an incentive payment and avoid future penalties. However, SLPs do not have six measures they are eligible to report; therefore when applicable, SLPs must report on all five measures that are available. They are:
See also: Explore 2023 MIPS Measures and Activities
See also: 2022 Part B Claims Submission Quick Start Guide [PDF]
All information included here is summarized from CMS’ Medicare Part B claims measure specifications and supporting documents [ZIP]. SLPs can use the search or filter functions within the CMS MIPS measures and activities tool to view and download full CMS measure specifications. See the appendix of the 2022 Part B Claims Submission Quick Start Guide [PDF] for an example of how measures are reported on a claim form.
Performance met
You completed and documented the quality action fully for that eligible encounter. You will receive points toward your overall score in the quality category.
Denominator exception
You did not perform the quality action for that eligible encounter because there was a documented medical reason the patient was not eligible for the quality action. You will receive partial points toward your overall score in the quality category.
Performance not met
You did not perform the quality action for that eligible encounter (for example, you forgot to perform the action or you forgot to report the quality code on the claim form). You will not receive any points and will lower your overall score in the quality category.
Performance met
.Current Medications: Medications the patient is presently taking including all prescriptions, over-the-counter, herbal and vitamin/mineral/dietary (nutritional) supplements with each medication’s name, dosage, frequency and administered route
Route: Documentation of the way the medication enters the body (some examples include but are not limited to: oral, sublingual, subcutaneous injections, and/or topical)
Not Eligible (Denominator Exception): A patient is not eligible if if there is documentation of a medical reason(s) for not documenting, updating, or reviewing the patient’s current medications list (e.g., 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).
Reporting Criteria | Patients 18 years and older with the following procedure code(s) for every billed encounter including telehealth visits. |
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CPT Codes | 92507, 92508, 92526, 92626, 97129 |
Quality Data Codes (QDCs) Pick one QDC to report on the same claim as the applicable CPT code. |
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G8427 Performance met |
Eligible clinician attests to documenting in the medical record that they obtained, updated, or reviewed the patient’s current medications. The list must include all known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements and must contain the medication’s name, dosage, frequency, and route of administration |
G8430 Denominator exception |
Documentation of a medical reason(s) for not documenting, updating, or reviewing the patient’s current medications list (e.g. patient is in an urgent or emergent medical situation) |
G8428 Performance not met |
Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given |
Screening: Completion of a clinical or diagnostic tool used to identify people at risk of developing or having a certain disease or condition, even in the absence of symptoms.
Standardized Depression Screening Tool: A normalized and validated depression screening tool developed for the patient population in which it is being utilized. The name of the age appropriate standardized depression screening tool utilized must be documented in the medical record. Examples of depression screening tools include but are not limited to:
Follow-Up Plan: Documented follow-up for a positive depression screening must include one or more of the following:
Not Eligible (Denominator Exclusion): To use QDC G8433 (screening not completed, documented patient or medical reason), the patient must either have a specific medical diagnosis or the medical record must reflect that the patient was unwilling or unable to participate in the screening.
Medical diagnoses that qualify for a denominator exemption include one or more of the following ICD-10-CM diagnoses related to depression or bipolar disorder: F01.51, F32.0-F32.5, F32.89, F32.9, F33.0-F33.3, F33.40-F33.42, F33.8, F33.9, F34.1, F34.81, F34.89, F43.21, F43.23, F53, O90.6, O99.340-O99.343, O99.345, F31.10-F31.13, F31.2, F31.30-F31.32, F31.4, F31.5, F31.60-F31.64, F31.70-F31.78, F31.81, F31.89, F31.9 (See the complete ICD-10-CM list for more detail on the range of codes).
ASHA Note: These diagnoses should be assigned by a physician or mental health professional and documented in the medical record.
Reporting Criteria | Patients 12 years and older with the following procedure code(s), reported a minimum of once per calendar year, per patient. |
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CPT Codes |
96105, 96112, 96125, 92625 |
Quality Data Codes (QDCs) Pick one QDC to report on the same claim as the applicable CPT code. |
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Reporting Criteria | |
G8431 Performance met |
Screening for depression is documented as being positive and a follow-up plan is documented |
G8510 Performance met |
Screening for depression is documented as negative, a follow-up plan is not required |
G8433 Denominator exception |
Screening for depression not completed, documented patient or medical reason |
G8432 Performance not met |
Depression screening not documented, reason not given |
G8511 Performance not met |
Screening for depression documented as positive, follow-up plan not documented, reason not given |
Screen for Elder Maltreatment: An elder maltreatment screen should include assessment and documentation of one or more of the following components: physical abuse, emotional or psychological abuse, neglect (active or passive), sexual abuse, elder abandonment, financial or material exploitation, and unwarranted control.
Physical Abuse: Infliction of physical injury by punching, beating, kicking, biting, burning, shaking, or other actions that result in harm.
Psychological Abuse: Willful infliction of mental or emotional anguish by threat, humiliation, isolation, or other verbal or nonverbal conduct.
Neglect: Involves attitudes of others or actions caused by others-such as family members, friends, or institutional caregivers-that have an extremely detrimental effect upon well-being.
Active Neglect: Behavior that is willful or when the caregiver intentionally withholds care or necessities. The neglect may be motivated by financial gain or reflect interpersonal conflicts.
Passive Neglect: Situations where the caregiver is unable to fulfill his or her care giving responsibilities as a result of illness, disability, stress, ignorance, lack of maturity, or lack of resources.
Note: Self-neglect is a prevalent form of abuse in the elderly population. Screening for self-neglect is not included in this measure. Resources for suspected self-neglect are listed under "Reporting Resources" below.
Sexual Abuse: Forcing of undesired sexual behavior by one person upon another against their will who are either competent or unable to fully comprehend and/or give consent. This may also be called molestation.
Elder Abandonment: Desertion of an elderly person by an individual who has assumed responsibility for providing care for an elder, or by a person with physical custody of an elder.
Financial or Material Exploitation: Taking advantage of a person for monetary gain or profit.
Unwarranted Control: Controlling a person’s ability to make choices about living situations, household finances, and medical care.
Follow-Up Plan: Must include a documented report to state or local Adult Protective Services (APS) or the appropriate state agency. Note: APS does not have jurisdiction in all states to investigate maltreatment of patients in long-term care facilities. In those states where APS does not have jurisdiction, APS may refer the provider to another state agency such as the state facility licensure agency for appropriate reporting.
Not Eligible (Denominator Exception): A patient is not eligible if one or more of the following reasons is documented:
*Documentation of an elder maltreatment screening must include identification of the tool used. Examples of screening tools for elder maltreatment include, but are not limited to: Elder Abuse Suspicion Index (EASI), Vulnerability to Abuse Screening Scale (VASS) and Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST). These tools are psychometrically sound instruments with demonstrated reliability and validity indices.
Reporting Criteria | Percentage of patients 65 years and older, reported a minimum of once a year when the following procedure code(s) are billed. |
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CPT Codes |
92521, 92522, 92523, 92524, 92610, 92626, 96112, 96125, 96105 |
Quality Data Codes (QDCs) Pick one QDC to report on the same claim as the applicable CPT code. |
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G8733 Performance met |
Elder maltreatment screen documented as positive AND a follow-up plan is documented |
G8734 Performance met |
Elder maltreatment screen documented as negative, follow-up is not required |
G8535 Denominator exception |
Elder maltreatment screen not documented; documentation that patient is not eligible for the elder maltreatment screen at the time of the encounter |
G8941 Denominator exception |
Elder maltreatment screen documented as positive, follow-up plan not documented, documentation the patient is not eligible for follow-up plan at the time of the encounter |
G8536 Performance not met |
No documentation of an elder maltreatment screen, reason not given |
G8735 Performance not met |
Elder maltreatment screen documented as positive, follow-up plan not documented, reason not given |
Federal reporting: In addition to state requirements, some types of providers are required by federal law to report suspected maltreatment. For example, nursing facilities certified by Medicare and/or Medicaid are required to report suspected maltreatment to the applicable State Survey and Certification Agency.
For state-specific information to report suspected elder maltreatment, including self-neglect, the following resources are available:
Standardized Tool: A tool that has been normed and validated. Examples of tools for functional outcome assessment include, but are not limited to: Oswestry Disability Index (ODI), Roland Morris Disability/Activity Questionnaire (RM), Neck Disability Index (NDI), Patient-Reported Outcomes Measurement Information System (PROMIS), Disabilities of the Arm, Shoulder and Hand (DASH), and Western Ontario and McMaster University Osteoarthritis Index Physical Function subscale (WOMAC-PF).
Functional Outcome Assessment: Patient completed questionnaires designed to measure a patient's limitations in performing the usual human tasks of living and to directly quantify functional and behavioral symptoms.
Current (Functional Outcome Assessment): A patient having a documented functional outcome assessment utilizing a standardized tool and a care plan if indicated within the previous 30 days.
Functional Outcome Deficiencies: Impairment or loss of function related to musculoskeletal/neuromusculoskeletal capacity, may include but are not limited to: restricted flexion, extension and rotation, back pain, neck pain, pain in the joints of the arms or legs, and headaches.
Care Plan: A care plan is an ordered assembly of expected/planned activities or actionable elements based on identified deficiencies. These may include observations, goals, services, appointments and procedures, usually organized in phases or sessions, which have the objective of organizing and managing health care activity for the patient, often focused on one or more of the patient’s health care problems. Care plans may also be known as a treatment plan.
Not Eligible (Denominator Exception): A patient is not eligible if one or more of the following reason(s) is documented at the time of the encounter:
Reporting Criteria | Percentage of visits for patients 18 years and older documentation of a current functional outcome assessment using a standardized functional outcome assessment tool on the date of the encounter AND documentation of a care plan based on identified functional outcome deficiencies on the date of the identified deficiencies. It must be reported at every visit to which it applies during the 2020 reporting period. |
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CPT Codes | 92610, 92611, 92612 |
Quality Data Codes (QDCs) Pick one QDC to report on the same claim as the applicable CPT code. |
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G8539 Performance met |
Functional outcome assessment documented as positive using a standardized tool AND a care plan based, on identified deficiencies on the date of the functional outcome assessment, is documented |
G8542 Performance met |
Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required |
G8942 Performance met |
Functional outcome assessment using a standardized tool is documented within the previous 30 days and a care plan, based on identified deficiencies on the date of the functional outcome assessment, is documented |
G8540 Denominator exception |
Functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool at the time of the encounter |
G9227 Denominator exception |
Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter |
G8541 Performance not met |
Functional outcome assessment using a standardized tool not documented, reason not given |
G8543 Performance not met |
Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented, reason not given |
This measure contains three submission criteria which aim to identify patients who were screened for tobacco use (submission criteria 1), patients who were identified as tobacco users and who received tobacco cessation intervention (submission criteria 2), and a comprehensive look at the overall performance on tobacco screening and cessation intervention (submission criteria 3).
Tobacco Use: Includes any type of tobacco
Tobacco Cessation Intervention: Includes brief counseling (3 minutes or less), and/or pharmacotherapy. Note: For the purpose of this measure, brief counseling (e.g., minimal and intensive advice/counseling interventions conducted both in person and over the phone) qualifies. Written self-help materials (e.g., brochures, pamphlets) and complementary/alternative therapies do not qualify. Brief counseling also may be of longer duration or be performed more frequently, as evidence shows there is a dose-response relationship between the intensity of counseling provided (either length or frequency) and tobacco cessation rates (U.S. preventative services task force, 2015).
Reporting Criteria | All patients 18 years and older, reported a minimum of once a year when the following procedure code(s) are billed. |
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CPT Codes | 92521, 92522, 92523, 92524 |
Quality Data Codes (QDCs) Pick one QDC to report on the same claim as the applicable CPT code. If you provided a screening and intervention during the same encounter, see Submission Criteria 2 or 3. |
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G9902 Performance met |
Patient screened for tobacco use and identified as a tobacco user |
G9903 Performance met |
Patient screened for tobacco use and identified as a tobacco non-user |
G9904 Denominator exception |
Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason) |
G9905 Performance not met |
Patient not screened for tobacco use, reason not given Note: Submit this QDC when a patient is screened for tobacco use and tobacco status is unknown. |
Reporting Criteria | All patients 18 years and older who were screened for tobacco use and identified as a tobacco user, reported a minimum of once a year when the following procedure code(s) are billed. |
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CPT Codes | 92521, 92522, 92523, 92524 |
Quality Data Codes (QDCs) Pick one QDC from Submission Criteria 2 and report with QDC G9902 from Submission Criteria 1 if the patient has been identified as a tobacco user. |
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G9906 Performance met |
Patient identified as a tobacco user received tobacco cessation intervention (counseling and/or pharmacotherapy) on the date of the encounter or within the previous 12 months Note: You must report two G-codes (G9902 and G9906) on the claim form for this quality action. |
G9907 Denominator exception |
Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months (e.g., limited life expectancy, other medical reason) Note: You must report two G-codes (G9902 and G9907) on the claim form when the quality action is not performed for documented medical reasons. |
G9908 Performance not met |
Patient identified as tobacco user did not receive tobacco cessation intervention on the date of the encounter or within the previous 12 months (counseling and/or pharmacotherapy), reason not given Note: You must report two G-codes (G9902 and G9908) on the claim form when the quality action is not performed and there is no reason given. |
Note: Unlike other measures reported using only G-codes, Submission Criteria 3 for measure 226 is reported using G-codes or CPT II codes that could include modifiers. If a modifier is required, it should be placed with the CPT II code in the modifier section in box 24D of the CMS-1500 claim form.
Reporting Criteria | All patients 18 years and older, reported a minimum of once a year when the following procedure code(s) are billed. |
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CPT Codes | 92521, 92522, 92523, 92524 |
Quality Data Codes (QDCs) Pick one QDC to report on the same claim as the applicable CPT code. Remember to append the appropriate modifier for a CPT II code, when indicated. |
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G0030 Performance met |
Patient screened for tobacco use and received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user |
1036F Performance met |
Current tobacco non-user |
G0028 Denominator exception |
Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason) |
G9909 Denominator exception |
Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months if identified as a tobacco user (e.g., limited life expectancy, other medical reason) |
G0029 Performance not met |
Tobacco screening not performed or tobacco cessation intervention not provided, reason not otherwise specified |
Quality Payment Program Help and Support
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American Speech-Language-Hearing Association
E-mail: reimbursement@asha.org