Including PQRS codes on a Billing Applet claim

Including PQRS codes on a Billing Applet claim

Per the CMS FAQ at

How and where should I place the Healthcare Common Procedure Coding System (HCPCS) CPT Category II codes or G-codes on the claim for the Physician Quality Reporting System (PQRS)?

The Physician Reporting quality-data codes (QDCs) HCPCS codes follow current rules for reporting other HCPCS codes (e.g., CPT Category I codes). In Billing Applet, you will enter PQRS codes as you do with other CPT Codes -- on the "Claim - Detail" screen.

As with any claim, CMS requires certain data elements to process the claim. These include, but are not limited to, the following:

  • Date of service;
  • Place of service;
  • PQRS CPT Category II codes or G-codes, along with modifier (if appropriate);
  • Diagnosis pointer;
  • Submitted charge ($0.00 should be entered for PQRS codes);
  • Rendering provider number (NPI).

Any PQRS codes submitted via a claim will always be denied by CMS but then tracked in the Physician Quality Reporting System. The Remittance Advice from CMS associated with the claim containing a PQRS code will include a standard Remark Code (N365) and a message that will read as follows: "This procedure code is not payable. It is for reporting/information purposes only." This remittance advice confirms that the Physician Quality Reporting code(s) passed into the National Claims History (NCH) file for use in calculating incentive eligibility. Eligible professionals should note that the submission of a non-zero charge amount with Physician Quality Reporting codes may complicate secondary payers' processing of the claims. Physicians and other eligible professionals are not allowed to collect any monies from beneficiaries for charges submitted for the Physician Reporting codes.

See the Physician Quality Reporting Implementation Guide for more details - 


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