2013 PQRS Toolkit

ACA Toolkit on the Medicare Physician Quality Reporting System:
Helping Doctors of Chiropractic Improve the Quality of Patient Care

The Centers for Medicare and Medicaid Services’ (CMS’) Physician Quality Reporting System (PQRS – formerly referred to as PQRI) will continue in 2013. Beginning January 1, 2013, physicians who report certain quality measures may be eligible for a 0.5% payment incentive, to be paid in the third quarter of 2014. To assist doctors of chiropractic who participate in this program, the ACA has compiled useful information developed by the ACA, the American Medical Association (AMA), as well as CMS, to help familiarize the chiropractic profession with the measures relevant to their practice and facilitate the data collection required to successfully report. 

Please Note: Providers who are not satisfactorily reporting during the 2013 reporting period will have their Medicare reimbursement decreased by 1.5% beginning in 2015.  Then, in 2016, the payment adjustment will increase to 2%.

Chiropractic participation in the PQRS is critical, as it demonstrates to CMS and the rest of the healthcare community that the chiropractic profession is serious about quality care improvement.  It is through the enhancement of quality patient care that the chiropractic profession will enhance its involvement in our nation’s health care delivery system.


For 2013, ACA has identified two (2) PQRS measures applicable to chiropractic practices. The measures include:

  • #131 – Pain Assessment and Follow-Up
  • #182 – Functional Outcome Assessment

(#124 – Health Information Technology: Adoption/Use of Electronic Health Records was retired at the end of 2012)

A complete list of all 264 individual quality measures and 26 measures groups for 2013 can be found here.


The information below outlines the measure specifications and data collection tools for the two (2) measures applicable to doctors of chiropractic in 2013.  Please click on the links listed below to view the following for each applicable measure:

1. Measure Description – This document describes what type of information is required to report on the measure and how frequently reporting is required.

2. Coding Specifications – This document includes a complete list of CPT® codes to identify patients eligible for the measure. A list of the quality codes for each measure is also included.  The coding specifications document is to be used in conjunction with the data collection sheet (see #3) to determine the appropriate code or combination of codes to be reported.

3. Data Collection Sheet – A step-by-step tool for clinical use and office/billing staff use.  It allows the physician to record the clinical information required for the measure by checking the appropriate box, and the coder to subsequently select the corresponding billing code.

#131 – Pain Assessment and Follow-Up Toolkit

#182 – Functional Outcome Assessment Toolkit


Physician Quality Reporting System Guidebook for Doctors of Chiropractic — Complete step by step directions on reporting, how to obtain your PQRS feedback reports, frequently asked chiropractic specific PQRS questions, and more.

2012 PQRS Toolkit – This toolkit is still available for use, as you have until February 22, 2013 to file PQRS for 2012.


2012 Physician Quality Reporting System: Claims Reporting Made Simple

CMS PQRS Frequently Asked Questions

CMS Medicare Physician Compare Initiative – CMS is required to post the names of eligible professionals and group practices who satisfactorily reported under the PQRS. This information should be publically available by January 1, 2013. For more information about the Physician Compare Website, click here.

To access all available PQRS educational resources, visit www.cms.hhs.gov/PQRS on the CMS Web site and click on the Educational Resources tab.