Powered by Oracle® RightNow

Physician Quality Reporting System Modifiers Fact Sheet

1P - Physician
2P - Physician
3P - Physician
8P - Physician

Definition: The only use of these modifiers is with CPT II codes for the Physician Quality Reporting System.

Information: The modifiers are broken into two categories exclusion modifiers (1P, 2P, 3P) and inclusion modifier (8P). The description below is from MM6514 and the link is provided at the bottom of the page.

1) Exclusion modifiers may be appended to a CPT II code to indicate that an action specified in the measure was not provided due to medical, patient, or system reason(s) documented in the medical record. These modifiers serve as denominator exclusions for the purpose of measuring performance. Some measures do not allow performance exclusions. Reasons for appending a performance measure exclusion modifier fall into one of three categories:

1P exclusion modifier due to medical reasons
Examples include: not indicated (absence of organ/limb, already received/performed, other); contraindicated (patient allergic history, potential adverse drug interaction, other); other medical reasons.

2P exclusion modifier due to patient reasons
Examples include: patient declined; economic, social, or religious reasons; other patient reasons.

3P exclusion modifier due to system reasons
Examples include: resources to perform the services not available (e.g., equipment, supplies); insurance coverage or payer-related limitations; other reasons attributable to health care delivery system.

2) The 8P reporting modifier is available for use only with CPT II codes to facilitate reporting a denominator eligible case when an action described in a measure is not performed and the reason is not specified. Instructions for appending this reporting modifier to CPT Category II codes are included in applicable measures. Use of the 8P reporting modifier indicates that the patient is eligible for the measure; however, there is no indication in the record that the action described in the measure was performed, nor was there any documented reason attributable to the exclusion modifiers.

8P reporting modifier - action not performed, reason not otherwise specified.

The 8P reporting modifier facilitates reporting an eligible case on a given measure when the quality action does not apply to a specific encounter. EPs can use the 8P reporting modifier to receive credit for satisfactory reporting but will not receive credit for performance.

CMS Message on 8P - Eligible professionals should use the 8P reporting modifier judiciously for applicable measures they have selected to report. The 8P modifier may not be used indiscriminately in an attempt to meet satisfactory reporting criteria without regard toward meeting the practice's quality improvement goals.

CMS References
Refer to CMS Physician Quality Reporting System Website for additional information on Physician Quality Reporting System and the modifiers used with it.

CMS PQRS website(external link)

You may also wish to view the Medicare Learning Network article at MM 6514
Coding and Reporting Principles for the Physician Quality Reporting Initiative (PQRI) and the Electronic Prescribing (E-Prescribing) Incentive Programs.

Page Last Updated: Tuesday, 15-Jul-2014 09:21:18 CDT