US · guidance
CMS Pub. 100-22, ch. 1, § 50.1
Claims-based Reporting Mechanism
Eligible professionals who choose to participate in Physician Quality Reporting System via the
claims-based reporting mechanism do not have to enroll or register with CMS to begin reporting
Physician Quality Reporting System quality measures data to CMS.
Participating eligible professionals whose Medicare patients fit the specifications of the
Physician Quality Reporting System quality measures and/or measures groups will simply report
on their claims the corresponding appropriate quality-data codes (QDCs), which are CPT
Category II codes or G-codes (where CPT Category II codes are not yet available). CPT
Category II codes and G-codes are Healthcare Common Procedure Coding System (HCPCS)
codes for reporting quality data. Claims-based reporting may be via: (1) the paper-based CMS
1500 Claim form or (2) the equivalent electronic transaction claim, the 837-P.
History
(Rev. 10, Issued: 07-27-12, Effective: 10-29-12, Implementation: 10-29-12)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
ff24874593ed9d0671e7dc4fac0f88255c951520870564daae7b2bd173145e1b
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