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  1. eCQM Issue Tracker
  2. CQM-5762

Does CPT code 99211 count as a qualifying encounter for certain measures?

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    • Icon: EC eCQMs EC eCQMs
    • Resolution: Answered
    • Icon: Moderate Moderate
    • None
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    • Christal Mandella
    • 16672392902
    • LifeBridge Health/Carroll CTO PHO
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      ​​Thank you for your inquiry.

      CMS69v10: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan. Qualifying encounters are those with codes from the "Encounter to Evaluate BMI" (2.16.840.1.113883.3.600.1.1751) value set. CPT code 99211 is not included in this value set and therefore does not count as a qualifying encounter for this measure.

      CMS2v11: Preventive Care and Screening: Screening for Depression and Follow-Up Plan. Qualifying encounters are those with codes from the "Encounter to Screen for Depression" (2.16.840.1.113883.3.600.1916) or "Physical Therapy Evaluation" (2.16.840.1.113883.3.526.3.1022) value sets. CPT code 99211 is not included in these value sets, and therefore does not count as a qualifying encounter for this measure.

      CMS122v10, Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) and CMS165v10, Controlling High Blood Pressure (2022 performance period). CPT code 99211 is not included in the measures' value sets (see below) that are used to define denominator qualifying encounters, and therefore does not count as a qualifying encounter for these measures..


      "Office Visit" 2.16.840.1.113883.3.464.1003.101.12.1001
      "Annual Wellness Visit" 2.16.840.1.113883.3.526.3.1240
      "Preventive Care Services - Established Office Visit, 18 and Up" 2.16.840.1.113883.3.464.1003.101.12.1025
      "Preventive Care Services-Initial Office Visit, 18 and Up" 2.16.840.1.113883.3.464.1003.101.12.1023
      "Home Healthcare Services" 2.16.840.1.113883.3.464.1003.101.12.1016


      You may review the codes contained within value sets on the Value Set Authority Center (VSAC) website at https://vsac.nlm.nih.gov/.
      Show
      ​​Thank you for your inquiry. CMS69v10: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan. Qualifying encounters are those with codes from the "Encounter to Evaluate BMI" (2.16.840.1.113883.3.600.1.1751) value set. CPT code 99211 is not included in this value set and therefore does not count as a qualifying encounter for this measure. CMS2v11: Preventive Care and Screening: Screening for Depression and Follow-Up Plan. Qualifying encounters are those with codes from the "Encounter to Screen for Depression" (2.16.840.1.113883.3.600.1916) or "Physical Therapy Evaluation" (2.16.840.1.113883.3.526.3.1022) value sets. CPT code 99211 is not included in these value sets, and therefore does not count as a qualifying encounter for this measure. CMS122v10, Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) and CMS165v10, Controlling High Blood Pressure (2022 performance period). CPT code 99211 is not included in the measures' value sets (see below) that are used to define denominator qualifying encounters, and therefore does not count as a qualifying encounter for these measures.. "Office Visit" 2.16.840.1.113883.3.464.1003.101.12.1001 "Annual Wellness Visit" 2.16.840.1.113883.3.526.3.1240 "Preventive Care Services - Established Office Visit, 18 and Up" 2.16.840.1.113883.3.464.1003.101.12.1025 "Preventive Care Services-Initial Office Visit, 18 and Up" 2.16.840.1.113883.3.464.1003.101.12.1023 "Home Healthcare Services" 2.16.840.1.113883.3.464.1003.101.12.1016 You may review the codes contained within value sets on the Value Set Authority Center (VSAC) website at https://vsac.nlm.nih.gov/ .
    • CMS0022v10, CMS0069v10, CMS0122v10
    • If 99211 counts as a qualifying measure, patients are being missed to capture key quality metrics.

      We'd like to confirm whether or not CPT code 99211 counts as a qualifying encounter for the following measures:

      CMS2_Screening for Depression and Follow Up Plan

      CMS165_Controlling High Blood Pressure

      CMS122_HbA1C Poor Control

      CMS69_BMI Screening and Follow Up

       

      Thank you!

            edave Mathematica EC eCQM Team
            cmandella Christal Mandella
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